不同手术方法治疗桡骨头Mason Ⅲ、Ⅳ型骨折的疗效分析

Open reduction and internal fixation vs. radial head resection in treatment of Mason Ⅲ or Ⅳ radial head fractures

目的 比较分析不同手术方法治疗桡骨头Mason Ⅲ、Ⅳ型骨折患者的疗效.方法 回颐性分析2002年1月至2008年12月采取不同手术方法治疗且获得随访的30例桡骨头MasonⅢ、Ⅳ型骨折患者资料,行切开复位内固定术组（切开组）19例,男12例,女7例;平均28.8岁（16～51岁）;左侧6例,右侧13例;Mason分型：Ⅲ型12例,Ⅳ型7例;合并尺骨鹰嘴骨折2例,冠状突骨折4例,内侧副韧带损伤3例.桡骨头切除（切除组）11例,男7例,女4例;平均33.2岁（20～55岁）;左侧4例,右侧7例;全部为Mason Ⅲ型;合并尺骨鹰嘴骨折1例,冠状突骨折3例,内侧副韧带损伤2例.同时处理合并的尺骨冠状突骨折和内侧副韧带损伤.比较两组患者的肌力减弱发生率、疼痛发生率、关节活动度减少、提携角增加、Broberg-Morrey肘关节功能评分.结果 切开组患者随访1.0～5.5年,平均30个月;切除组患者随访2～6年,平均33个月.两组患者术后腕部疼痛发生率、屈伸活动度减少、提携角增加差异均有统计学意义（P＜0.05）,切除组较切开组提携角明显增大,其中改变最明显的1例（切除术后6年者）提携角增大18°.其他指标比较差异均无统计学意义（P＞0.05）.Broberg-Morrey肘关节功能评分,切开组：优5例,良9例,可4例,差1例;切除组：优1例,良6例,可3例,差1例.结论 桡骨头MasonⅢ、Ⅳ型骨折行切开复位内固定术治疗的关节功能恢复满意,且长期并发症较桡骨头切除术少,建议对此类患者应尽量保留桡骨头,行切开复位内固定.

Objective To analyze the clinical results of open reduction and internal fixation （ORIF）vs. radial head resection （RHR） in treatment of patients with a Mason Ⅲ or Ⅳ radial head fracture.Methods We enrolled 30 patients with a Mason Ⅲ or Ⅳ radial head fracture who had been treated in our department from January 2002 to December 2008. In this study, 19 cases received ORIF and 11 cases underwent RHR. The fracture of ulna coronoid process and the medial collateral ligaments were treated at the same time. The 2 groups were compared in muscle weakness, wrist pain, joint range of motion, carrying angel and Broberg-Morrey functional rating score. Results The ORIF group was followed up for 1.0 to 5.5 years, with an average of 30 months. The RHR group was followed up for 2 to 6 years, with an average of 33 months. The postoperative wrist pain and the carrying angle were significantly increased in the RHR group（ P 〈 0.05） . Broberg-Morrey score system showed a good to excellent rate of 74% （14/19） in the ORIF group and a good to excellent rate of 64%（6/11 ） in the RHR group, with no significant difference between the 2 groups （ P = 0. 429）. Conclusion In treatment of a Mason Ⅲ or Ⅳ radial head fracture, ORIF may be preferred because the radial head is preserved as far as possible so that the patient may have better prognosis.