可吸收自身增强软骨钉治疗桡骨小头骨折

The application of absorbable self-enhancing cartilage nails in the treatment of radial head fractures

目的评估可吸收自身增强软骨钉治疗桡骨小头骨折的临床疗效。方法回顾性分析2008年1月至2011年12月采用切开复位、可吸收自身增强软骨钉固定治疗22例桡骨小头骨折患者资料，其中18例资料完整，男10例，女8例；年龄13-55岁，平均36．8岁；左侧10例，右侧8例。按Mason分型：Ⅱ型14例，Ⅲ型3例，Ⅳ型1例；其中2例合并桡骨颈骨折，9例合并肱骨小头软骨骨折，1例合并肘关节后脱位伴尺骨鹰嘴撕脱性骨折。术中对桡骨小头骨折复位后先以克氏针临时固定，再用直径为1．5mm、长度为16-24mm可吸收自身增强软骨钉固定，螺钉不穿过对侧骨皮质，螺钉头埋入软骨下；对同时存在的颈部骨折，先复位桡骨小头，以软骨钉固定，再复位颈部，用微型“T”形钢板或解剖型钢板固定。对合并肱骨小头骨软骨骨折，其中4例给予软骨片复位、可吸收缝线经肱骨外上髁固定，5例因骨软骨片较小无法固定而去除。结果18例患者均获得随访，随访时间6-54个月，平均31-3个月；骨折均顺利愈合，愈合时间5-12周，平均8．7周。随访时无一例出现内固定失败、血肿、积液、窦道形成、桡骨小头溶骨性变化等并发症。Broberg—Morrey评分为68-100分，其中优13例，良4例，可1例，优良率为94．44％（17／18）。术后肘关节屈伸活动度为90°-150°，平均123．8°；前臂旋转活动度为130°～180°，平均152．5°。结论可吸收自身增强软骨钉可治疗各种类型桡骨小头骨折，术后疗效满意。

Objective To evaluate the clinical effect of absorbable self-enhancing cartilage nails in the treatment of radial head fractures. Methods Data of 22 patients with radial head fractures, who had un- dergone open reduction and internal fixation with absorbable self-enhancing cartilage nails from January 2008 to December 2011, were retrospectively analyzed. Among them, data of 18 patients were complete, in- cluding 10 males and 8 females. According to the Mason classification, there were 14 cases of Mason II, 3 cases of Mason III and 1 case of Mason IV. Two patients were combined with radial neck fractures, 9 with osteoehondral fractures of capitellum, and 1 with posterior dislocation of the elbow and olecranon avulsion fracture. The radial head fractures were temporarily fixed with Kirschner wires after open reduction, then ab- sorbable self-enhancing cartilage nails with length from 16 to 24 mm and diameters of 1.5 mm were applied to reach final fixation. The heads of nails were right underneath of cartilages without penetrating bone cor- texes on the contralateral side. The radial neck fractures were reduced and fixed with T-plates or anatomical plates after the radial head fractures were fixed with cartilage nails. Four cases of osteochondral fracture of capitellum were fixed with absorbable sutures to external epicondyle of humerus. For other 5 cases of osteo- chondral fracture of capitellum, the bone fragments were removed due to too small to fix. Results All 18 patients were followed up for 6 to 54 months （average, 31.3 months）. All fractures achieved bone union, and the healing time ranged from 5 to 12 weeks （average, 8.7 weeks）. There were no complications, such as inter- nal fixation failure, nonunion, hematoma, sinus formation, osteolytic changes of radial heads and so on. Ac- cording to the Broberg-Morrey elbow performance score, 13 cases were excellent, 4 good, and 1 fair, with the total excellent and good rate of 94.44% （17/18）. At final follow-up, the elbow range of motion was 90° to 150° （average, 123.8°）, and the range of forearm rotation was 130° to 180° （average, 152.5°）. Conclusion Absorbable self-enhancing cartilage nails can be used to treat various kinds of radial head fractures, and the results are satisfactory.