不同内固定方法治疗Mason Ⅱ型桡骨头骨折临床效果的对比研究

Comparative study on the clinical results of treatment of Mason type-Ⅱ radial head fracture by different internal fixation

[目的]比较研究Herbert钉、微型空心松质骨螺钉、微型皮质骨螺钉以及克氏针内固定治疗MasonⅡ型桡骨头骨折的临床效果。[方法]1999年1月-2005年7月共收治34例MasonⅡ型桡骨头骨折,7例行Herbert钉内固定术(1组),10例行微型空心松质骨螺钉内固定术(2组),9例行微型皮质骨螺钉内固定术(3组),8例行克氏针内固定术(4组)。通过随访对4组患者肘关节的疼痛、功能评分以及运动、肌力、X线表现进行比较研究。[结果]术后随访2～6年,平均4.5年,4组平均肘关节痛觉满意视觉模拟评分(VAS评分)分别为24.2、23.7、21.5和19.7分(P<0.01),平均Broderg和Morrey肘关节功能评分分别为93.3、94.1、91.4和86.3分(P<0.01);4组患者肘关节伸、屈以及前臂旋前活动度差异有统计学意义(P<0.01),但伸肘、屈肘肌力以及旋前和旋后肌力差异无显著性(P>0.01),均正常。[结论]与克氏针内固定相比,切开复位Herbert钉、微型空心松质骨螺钉以及微型皮质骨螺钉内固定治疗MasonⅡ型桡骨头骨折可获得较满意的关节活动范围以及较好的关节功能恢复。

[ Objective ] To compare the clinical results of treatment of Mason type- Ⅱ radial head fracture by open reduction and internal fixation with Herbert screw, micro-cannulated screw, micro-cartical screw and Kirschner wire. [ Method ] Thirty-four cases of Mason type- Ⅱ radial head fracture were treated from Jan. 1999 to July 2005. Seven cases had internally fixed with Herbert screws （ group 1 ） , 10 with micro-cannulated screws （ group 2 ） , 9 with micro-cartical screws （ group 3 ） , and 8 with Kirschner wires （ group 4）. The outcomes were assessed with regard to the pain, elbow functional rating score and motion, strength, radio- graphic findings. [ Result ] The mean follow-up was 4.5 （2-6） years. The averaged pain VAS score was 24.2,23.7,21.5 and 19. 7, respectively, with a P value of 0.0046. And the mean Broberg and Morrey functional rating score was 93.3,94.1,91.4 and 86. 3 （ P = 0. 0069）. The elbow extension, flexion and the forearm anterior rotation range differed statistically among the 4 groups （ P 〈0.01 ） ,but the strength of elbow extension ,flexion and forearm rotation showed no statistical difference among the 4 groups（ P 〉 0.01 ）. [ Conclusion] Compared to internal fixation with wires,open reduction and internal fixation with Herbert screws, micro- cannulated screws and micro-cartical screws can result in more satisfying elbow motion and better functional recovery in treating Mason type-Ⅱ radial head fracture.