桡骨小头骨折与前臂骨间膜损伤的相关性研究

A high correlation between radial head fracture and forearm interosseous membrane injury

目的探讨桡骨小头骨折与前臂骨间膜损伤的相关性。方法2007年9月至2010年6月，前瞻性观察26例桡骨小头骨折患者，男15例，女11例；年龄21-53岁，平均（37．6±7.3）岁。桡骨小头骨折根据Mason分型，I型7例，Ⅱ型9例，Ⅲ型10例。所有患者均在1周内行伤侧尺桡骨全长X线、CT及MR检查（包括肘及腕关节），以明确是否合并前臂骨间膜损伤及损伤程度、部位。桡骨小头骨折类型和骨间膜损伤程度的相关性采用Spearman秩相关进行统计学分析。结果MasonI-Ⅲ型桡骨小头骨折均可伴前臂骨间膜损伤，其中7例MasonI型骨折中2例、9例MasonⅡ型骨折中4例、10例MasonⅢ型骨折中7例伴前臂骨间膜损伤。桡骨小头骨折与前臂骨间膜损伤呈正相关。桡骨小头骨折程度越严重，前臂骨间膜损伤的发生率越高，损伤程度也越重。MasonI型及Ⅱ型骨折中的6例前臂骨间膜损伤均为膜部损伤，而10例Masonm型骨折中的7例前臂骨间膜损伤，3例为中央束断裂，4例为膜部损伤。结论各类型桡骨小头骨折均可伴前臂骨间膜损伤，桡骨小头骨折与前臂骨间膜损伤呈正相关。对于桡骨小头骨折，尤其是MasonⅢ型骨折，建议行前臂MR检查，以明确是否有骨间膜损伤。

Objective To evaluate correlation of radial head fracture with forearm interosseous membrane （IOM） injury. Methods Twenty-six patients with radial head fractures were studied prospectively between September 2007 and June 2010. There were 15 men andl 1women, with an average age of 37.6＇years （range, 21-53）. According to the Mason classification, there were 7 cases of type I, 9 cases of type II, 10 cases of type III. All patients were subjected to forearm X-ray, CT scans and the MR within a week. Clinical and radiographic data of all the patients were collected. Spearman rank correlation statistical analysis was used to analyze the correlation between the radial head fracture and the IOM injury. Results The radial head fractures and IOM injury were directly related. The IOM injury was noted in all type of radial head fracture. The more severity radial head fracture had, the more IOM injury happened. In Mason I-III frac- tures, IOM injury was found in 2, 4 and 7 cases respectively. The different degree of radial head fracture caused different effects on IOM injury. The severity of radial head fracture was correlated with damage degree of IOM. In Mason type I and type II fractures, the IOM injury were just partial disruption with distal part of the IOM and did not reach the biomechanically essential central band. In type III fractures, central band disruption was found in 3 cases. Conclusion Mason I-III radial head fractures are associated with forearm IOM injury. There was a positive correlation between radial head fractures and IOM injury. If IOM lesions are suspected, magnetic resonance imaging should be performed, especially Mason III fractures.