成人桡骨近端的解剖学研究及临床应用

Anatomical study of the proximal end of the radius in adults and its clinical application

目的为临床采用改良式预弯微型钢板治疗成人粉碎性桡骨头骨折提供桡骨近端的解剖依据,并探讨其疗效。方法在32副成人干燥桡尺骨标本上,对桡骨近端、桡骨头环状关节面与尺骨桡切迹之间的动态关系等,进行观测。1988年1月～1998年3月,采用改良式预弯微型钢板治疗粉碎性桡骨头骨折11例,按照Mason标准分型,桡骨头Ⅲ型骨折9例,Ⅳ型骨折2例。结果桡骨近端长度平均为41.6mm。桡骨颈干角为164°。在前臂中立位、最大旋前位和最大旋后位时,环状关节面与尺骨桡切迹的接触弧度和非接触弧度分别平均为69°,108°,45°和138°。全部病例随访1年8个月～3年2个月,均获得骨性愈合,平均骨折愈合时间为8.5个月。按照Broberg和Morrey标准进行综合评定,优6例,良4例,可1例。结论改良式预弯微型钢板治疗粉碎性桡骨头骨折,是一种安全有效的手术方法。

Objective To provide the anatomical basis for treatment of comminuted fractures of the radial head with bending steel miniplates by observations of the proximal end of the radius (PEOTR) in adults and to investigate the effect of its application. Methods The PEOTR and the dynamic relationship between the articular circumference of the radial head and the ulnar radial notch were studied with 32 pairs of specimen of the dried radii and ulnae in adults. From Jan 1988 to Mar 1998, eleven cases of comminuted fractures of the radial head were treated with bending steel miniplates procedure; there were seven males and four females, with an average age of 35 years. According to Mason's grading, 9 cases were classified as Type Ⅲ radial head fractures, 2 cases as Type Ⅳ radial head fractures. Results The average length of the PEOTR was 41.6 mm. The radial neck deviated from the radial shaft at an angle of 164°. Then at the neutral position, the greatest range of pronation and supination of the forearm, the range of contact of radians and the range of non contact radian between the articular circumference of the radial head and the ulnar radial notch were 69°,108°,45° and 138°, respectively. The period of follow up in all cases was 20-38 months. All had bony union, with an average healing time of 8.5 months. Evaluation was done according to the criterion made by Broberg and Morrey. The result was excellent in 6 cases, good in 4 cases, and fair in 1 case. Conclusion The treatment of comminuted fractures of the radial head with bending steel miniplates is a safe and effective method.