第三代可吸收棒治疗成年人MasonⅡ-Ⅳ型桡骨头骨折的疗效探讨

Efficacy of third-generation absorbable rods in the treatment of Mason type Ⅱ-Ⅳ radial head fractures in adults

[目的]探讨应用第三代可吸收棒骨内固定治疗成人MasonⅡ-Ⅳ型桡骨头骨折的方法、可行性及临床疗效。[方法]选取本院及合作医院2010年8月～2013年3月收治的桡骨头骨折病人80例作为研究对象，通过肘外后小切口显露桡骨头，应用多枚第3代可吸收棒（直径2mm）交叉骨内固定骨折的桡骨小头，术后石膏固定3～4周开始功能锻炼，定期随访复查x线，按Metaizeau肘关节评分标准进行功能评价，比较其对不同类型桡骨头骨折的临床疗效。[结果]切口愈合率100％；术后随访1—3年，平均（1．7±0．5）年；按Metaizeau的肘关节评分标准：Mason—Ⅱ型桡骨头骨折的28例中，优20例，良8例，可0例，差0例；Mason一Ⅲ型桡骨头骨折的41例中，优17例，良13例，可1例，差0例；而Mason—Ⅳ型桡骨头骨折的11例中，优1例，良7例，可2例，差1例。可见，第3代可吸收棒治疗Mason—Ⅱ型桡骨头骨折的疗效最佳，其次为Mason—Ⅲ型，而疗效最差的为Mason—Ⅳ型。80例患者中有1例Mason—Ⅳ桡骨头骨折患者因并发症需进行2次手术。[结论]应用第3代可吸收棒内固定治疗成人桡骨头骨折操作简便，切口隐蔽，创伤小，并发症少，避免内固定物取出术，减少病人痛苦，值得在临床上推广使用。

[ Objective] To explore the methods, feasibility, and clinical efficacy of third- generation absorbable rods in the treatment of Mason type Ⅱ- Ⅳ radial head fractures in adults. [ Method] From August 2010 to March 2013,80 patients from our hospital with a radial head fracture were enrolled. The radial head was revealed through a small incision on the outer elbow. Thirdgeneration absorbable rods （diameter 2 mm） were used to cross fix the radial head fracture. The patient participated in functional exercise 3 - 4 weeks after cast immobilization. Radiographs were reviewed during the regular follow - up, and the patient＇s functional status was evaluated according to Metaizeau elbow score standards. The clinical efficacy of different types of radial head fractures was comparcd.[ Result] The wound healing rate was 100%. The postoperative follow - up duration was 1 - 3 years （ average, 1.7 ± 0.5 years）. Based on Metaizeau elbow score standards, among 28 cases of Mason type Ⅱ radial head fractures, the score was excellent in 20, good in 8, medium in 0, and poor in 0 patients ; among 41 cases of Mason type Ⅲ radial head fractures,the score was excellent in 17 ,good in 13 ,medium in 1 ,and poor in 0 patients; among 11 cases of Mason type Ⅲ radial head fractures, the score was excellent in 1, good in 7, medium in 2, and poor in 1 patient. The use of third - generation absorbable rods demonstrated the best result in Mason type Ⅱ radial head fractures, followed by Mason type Ⅲ, and the worst result in Mason type Ⅳ fractures. One patient with Mason type Ⅲ radial head fracture required a second surgery due to complications. [ Conclusion] The use of third - generation absorbable rods in the treatment of Mason type Ⅱ - Ⅳ radial head fractures requires a simple surgical technique with a hidden incision,lesser trauma, and fewer complications. Its use helps avoid fixator removal surgery and thereby reduces patient suffering,which is considered a worthy cause in clinical practice.