假体置换与切开复位内固定对不同数量骨折碎片的桡骨头骨折近期疗效分析

Recent therapeutic effectiveness of prosthetic replacement versus open reduction and internal fixation for treatment of radial head fractures with different quantity of fragments

目的 研究比较假体置换术与切开复位内固定术对不同数量骨折碎片的桡骨头骨折的疗效。方法 本院自2006-02—2013-04诊治桡骨头骨折42例,根据骨折碎片的数量分为2组。Ⅰ组22例（骨折碎片〉3个）：12例行假体置换（ⅠA组）,10例行切开复位内固定（ⅠB组）。Ⅱ组20例（骨折碎片≤3个）：12例行假体置换（ⅡA组）,8例行切开复位内固定治疗（ⅡB组）。结果 2组术后平均随访28.5（15-35）个月。Ⅰ组：22例均获骨性愈合,ⅠA组和ⅠB组VAS评分差异无统计学意义,ⅠA组在屈伸活动度、前臂旋转活动度、提携角和尺侧位移以及Broberg和Morrey肘关节功能评分均优于ⅠB组,2组间比较差异有统计学意义（P〈0.05）。Ⅱ组：20例均获骨性愈合,ⅡB组和ⅡA组在VAS评分、尺侧位移、肘关节伸直、前臂旋前、Broberg和Morrey肘关节功能评分差异无统计学意义（P〉0.05）,2组在提携角、肘关节屈曲、前臂旋后差异有统计学意义（P〈0.05）。结论 本研究表明,桡骨头骨折碎片〉3个时假体置换的治疗效果优于切开复位内固定术;骨折碎片≤3个时两者治疗效果无明显差异。

Objective To study the effectiveness of prosthetic replacement versus open reduction and internal fixation for treatment of radial head fractures with different quantity of fragments. Methods Forty-two patients with complex radial head fractures were enrolled in the study. According to the number of the fracture fragments the patients were divided into two groups. Group I consisted of 22 patients（the average fracture fragments greater than 3）： 12 patients underwent prosthetic replacement（PR）; 10 patients underwent open reduction and internal fixation（ORIF）. Group II with 20 patients（the average fracture fragments less than or equal to 3）： 12 patients underwent PR; 8 patients underwent ORIF. The overall outcome was rated with the functional rating score described by Broberg and Morrey. Results All patients were followed up for 15-35 months, with an average of 28.5 months. Group I ： there was significant difference in flexion and extension activity of the elbow, forearm rotation angle, carrying angle, ulnar variance and Broberg and Morrey elbow scores between two kinds of treatment（P〈0.05）. Group II： There was no significant difference in Broberg and Morrey elbow scores between two kinds of treatment（P〉0.05）. Conclusion Our data suggest that, in the condition of the fragments greater than 3, prosthetic replacement is superior to open reduction and internal fixation; there is no significant difference between two kinds of treatment within the fragments less than or equal to 3.