空心双头加压螺钉在桡骨小头骨折内固定术中的应用

Applying double-head hollow compression screw in internal fixation of radial head fractures

目的 探讨应用空心双头加压螺钉内固定治疗MasonⅡ、Ⅲ型挠骨小头骨折的可行性及优点.方法 2008年3月至2013年1月,我科90例MasonⅡ、Ⅲ型挠骨小头骨折手术病人,随机分A、B两组,每组45例,A组应用空心双头加压螺钉内固定,B组应用微型T形锁定钛板内固定.术后从肘关节活动度、X线片表现、患者满意度及Broberg和Morrey功能评分等进行疗效评定.结果 所有病例骨折均愈合,愈合时间8～ 15周;无桡骨头坏死发生;A组：手术时间平均50.2分钟（41 ～ 70分钟）.术后随访平均24.5个月（12 ～ 48个月）.肘关节屈曲伸直弧度平均132.8度;前臂旋前旋后弧度170.5度.Broberg和Morrey肘关节评分平均97.6分,优38例,良6例,可1例,优秀率84.4％.患者满意度平均9.7分.B组：手术时间平均82.2分钟（65～100分钟）.术后随访平均25.2个月（12 ～ 50个月）.肘关节屈曲伸直弧度平均123.2度,前臂旋前旋后弧度平均152.5度.Broberg和Morrey肘关节评分平均88.4分,优25例,良15例,可5例,优秀率55.5％.患者满意度平均8.2分.两组相比差异有统计学意义（P＜0.05）.结论 应用空心双头加压螺钉内固定治疗Mason Ⅱ型及部分MasonⅢ型桡骨小头骨折,有手术操作简便,复位固定满意、利于早期功能锻炼、功能恢复好、并发症少、患者满意度高等优点,是一种较实用的手术方法.

Objective To explore the feasibility and advantages of double-head hollow compression screw in internal fixation of Mason type Ⅱ and Ⅲ radial head fractures. Methods From Mar.2008 to Jan. 2013, 90 patients with Mason type-Ⅱ and Ⅲ radial head fracture undergoing operation in our department were randomly divided into group A and group B, 45 cases for each group. Group A were internally fixed with double-head hollow compression screw, and group B with micro T shape Xocking titanium plate. The ranges of motion, radiographic findings, patients＇ satisfaction degrees, and Broberg and Morrey elbow performance scores were compared between the 2 groups. Results 8-15 weeks after the operation, all patients recovered from the fractures without ischemic necrosis. The average operation time was 50.2 min（41-70 rain）, the patients were followed up average 24.5 month（12-48 months）, the mean range of flexion and extension at the elbow was 132.8° , the patients could turn their forearms back average 170.5° , the patients＇ satisfaction score was 9.7, and the average Broberg and Morrey score was 97.6, showing that 38 cases recovered excellently, 6 well, and 1 so so, with a excellent rate of 84.4% in group A. The average operation time was 82.2 min（65-100 rain）, the patients were followed up average 25.2 month（12-50 months）, the mean range of flexion and extension at the elbow was 123.2° , the patients could their forearms back average 152.5° , the patients＇ satisfaction score was 8.2, and the average Broberg and Morrey score was 88.4, showing that 25 cases recovered excellently, 15 well, and 5 so so, with a excellent rate of 55.5% in group B. There were statistical differences between the two groups（P 〈 0.05）. Conclusions Internally fixing Mason type Ⅱ andⅢ radial head fractures with the double-head hollow compression screw is a practical method with the advantages of easy to operate, good reduction and implant position, earlier functional exercise, better elbow motion and function, fewer complications, and better patient satisfaction.