可吸收棒交叉内固定治疗严重移位桡骨颈骨折

Crossed Internal Fixation with Absorbable SR-PLLA Rods for the Treatment of the Severe Displaced Radial Neck Fractures

目的探讨可吸收棒治疗桡骨颈骨折的可行性及治疗效果。方法 2005年3月～2011年12月共收治28例严重移位的桡骨颈骨折,骨折按Mason分型,Ⅱ型16例,Ⅲ型12例;按Morris分型,Ⅱ型11例,Ⅴ型17例;所有手术患者桡骨颈移位成角平均为60°(20°～100°),侧方移位平均为10(5～15)mm;手术距受伤时间平均4(3～7)d。采用臂丛麻醉下切开复位,可吸收棒内固定,Morris分型Ⅱ型11例采用单棒固定,Ⅴ型17例均采用2枚交叉固定,其中3例粉碎性骨折,加入可吸收线交叉捆扎,术后屈肘中立位石膏托外固定3～4周,回顾性分析其临床效果。结果 28例均获随诊,时间平均6(1～8)个月,经X片证实均达骨性愈合,平均愈合时间为5(2～6)个月。肘关节屈伸、前臂旋转功能未见明显障碍。结论桡骨颈骨折治疗方法选择不恰当会造成肘关节及前臂旋转功能障碍,采用可吸收棒治疗内固定牢靠,避免术后二次手术,术后并发症少,值得临床推广应用。

Objective To explore the feasibility and clinical efficacy of crossed internal fixation with ab sorbable SR-PLLA rods for the treatment of the severe displaced radial neck fractures. Methods Clinical da ta was retrospectively analyzed in 28 patients with severe displaced fractures of radial neck. There werel6 cases of Mason Ⅱ and 12 cases of MasonⅢ ; while 11 cases of MorrisⅡ and 17 cases of Morris V. The average angula- tion of the radial neck was 60°, with 20°～ 100° in range. All the cases were open operated under brachial plexus anesthesia. The shifted radial necks received open reduction and fixation with absorbable SR-PLLA rods. Single rod was used in 11 cases of Morris Ⅱ , and double rods were used in Morris V. And there were 3 cases of comminuted fractures were fixed by the absorbable suture cross strapping. The elbow was external fixed by the piaster slab in neutral position for 3 to 4 weeks after operation. Results All the 28 cases were followed up for 1 to 8 months, with 6 months in average. The bone fractures got osseous heal in 2 -6 months, with 5 months in average. There was no obvious dysfunction of the elbow joint. Conclusions It can provide reliable fixation and satisfactory effect of the crossed internal fixation with absorbable SR-PLLA rods for the treatment of the se- vere displaced radial neck fractures. It is worthy to be popularized for its avoidance of a second operation to re- move the internal fixation and its low complication rate.