微型钛板内固定治疗复杂桡骨头骨折

Open Reduction and Micro-plate Internal Fixation for Complex Radial Head Fractures

目的探讨运用微型钛板治疗复杂桡骨头骨折的可行性及疗效。方法 21例复杂桡骨头骨折患者,采用手术切开复位、微型钛板内固定的方法治疗,其中MasonⅡ型14例,Ⅲ型7例。均采用肘关节后外侧切口,骨折复位后克氏针辅助固定,再行指骨钛板螺钉固定,确认关节面平整,关节旋转及伸屈运动无阻碍。术后予石膏外固定2～4周,石膏拆除后开始渐进的功能锻炼。结果本组手术时间50～80 min,平均(65±15)min。均获随访,平均随访时间14.5(5～24)个月,术后3～5个月骨折均获骨性愈合,肘关节屈平均115°(110°～125°),伸平均5°(0°～10°),旋前平均55°(50°～60°),旋后平均50°(40°～60°)。1例遗留轻度肘关节疼痛;无肘关节外翻不稳定及创伤性关节炎发生。根据Broberg和Morrey评分评价肘关节功能:优8例,良10例,可3例,优良率85.7%。结论运用微型钛板固定桡骨头骨折安全可行,能更好地恢复桡骨头关节面的解剖结构,并有效固定,为早期肘关节功能锻炼提供了稳定性,有利于肘关节功能的恢复。

Objective To investigate the feasibility and effect of micro-plate internal fixation of complex radial head fractures.Method Twenty-one patients with radius head fractures were treated by open reduction and micro-plate internal fixation,including type Ⅱ in 14 cases and type Ⅲ in 7 cases according Mason classification.Results The operation time ranged 50 to 80 minutes with an average of（65±15） minutes.All cases were followed up for 14.5 months（ranged from 5 to 24 months）.All fractures obtained bone union in 3 to 5 months after the operation.The range of flexion,stretch,pronation and supination of the elbow joints was 110°~125°（mean,115°）,0°~10°（mean,5°）,50°~60°（mean,55°）and 40°~60°（mean,50°） respectively.There was no elbow valgus and traumatic arthritis.One case complicated with mild elbow pain.According to Broberg and Morrey criteria,the surgical outcomes were excellent in 8 cases,good in 10 cases,fair in 3 cases,and the fineness rate was 85.7%.Conclusion Open reduction and micro-plate internal fixation of complex radial head fracture can provide an anatomical reduction,stable fixation and early range of motion.