移位桡骨头骨折的内固定治疗

TREATMENT OF DISPLACED RADIAL HEAD FRACTURES WITH INTERNAL FIXATION

目的探讨内固定治疗移位桡骨头骨折的方法和临床疗效。方法 2005年8月-2009年5月,采用切开复位、可吸收软骨固定钉和/或AO微型接骨板内固定治疗移位桡骨头骨折35例。男28例,女7例;年龄17～48岁,平均28.4岁。致伤原因:交通事故伤16例,摔伤13例,高处坠落伤6例。骨折根据Mason分型:Ⅱ型21例,Ⅲ型9例,Ⅳ型5例。均为闭合性骨折,其中合并桡骨颈骨折6例,尺骨鹰嘴骨折1例,肘关节后脱位3例,肘关节后脱位和尺骨冠状突骨折1例,尺侧副韧带损伤3例。伤后至手术时间3～7d。结果术后1例切口感染Ⅱ期愈合;其余患者切口均Ⅰ期愈合。35例均获随访,随访时间12～25个月,平均17个月。骨折均获骨性愈合,愈合时间8～16周,平均10.2周。末次随访时,肘关节屈伸达95～145°,平均119°;旋转(旋前加旋后)90～175°,平均126°。肘关节功能根据Broberg和Morrey肘关节评分标准评定,获优18例,良13例,可4例,优良率88.6%。结论对于移位桡骨头骨折,根据骨折类型选择可吸收软骨固定钉和/或AO微型接骨板内固定治疗,近期疗效满意。

Objective To analyse the procedure and effectiveness of internal fixation in treatment of displaced radial head fractures.Methods Between August 2005 and May 2009,35 patients with displaced radial head fractures underwent open reduction and internal fixation with SmartNail and/or AO mini-plates.There were 28 males and 7 females with an average age of 28.4 years（range,17-48 years）.The injury mechanism included traffic accident in 16 patients,falling in 13,and falling from height in 6.According to Mason classification,21 fractures were rated as type II,9 as type III,and 5 as type IV.All fracturs were closed fractures.Six cases complicated by radial neck fractures,1 case by olecranon fracture,3 by posterior dislocations of the elbow,1 by posterior dislocation of the elbow and coronoid process fracture,and 3 by medial collateral ligament injuries.The time from injury to operation was 3 to 7 days.Results Except 1 patient whose incision healed by second intention,healing of incision by first intention was achieved in the other patients.All patients were followed up 12-25 months with an average of 17 months.The average fracture healing time was 10.2 weeks（range,8-16 weeks）.At last follow-up,the average flexion and extension of the elbow was 119°（range,95-145°）.The average arc of forearm rotation was 126°（range,90-175°）.According to elbow functional evaluation criteria by Broberg and Morrey,the results were excellent in 18 cases,good in 13,and fair in 4;the excellent and good rate was 88.6%.Conclusion In treatment of displaced radial head fractures,open reduction and internal fixation can be performed with SmartNail and/or AO mini-plates based on different fracture types and the short-term effectiveness is satisfactory