桡骨头骨折与伴发损伤的关系及治疗方式的研究

Clinical significances of associated injuries of radial head fracture

目的探讨桡骨头骨折与伴发损伤的关系及对治疗方式选择的影响。方法回顾性分析2013年12月至2015年12月收治桡骨头骨折患者资料，记录患者的性别、年龄、受伤侧别、致伤原因、骨折Mason分型、伴发损伤、治疗方式等数据。采用单因素相关分析骨折Mason分型与伴发损伤数量的关系，及年龄、Mason分型、伴发损伤数量对治疗方式选择影响。结果共收集61例桡骨头骨折患者，男32例，女29例，男女比为1．1：1；年龄20～78岁，平均40岁。左侧31例，右侧29例，双侧1例。骨折Mason分型：I型17例，Ⅱ型30例，Ⅲ型9例，Ⅳ型5例。伴发损伤：侧副韧带损伤47例，冠状突骨折5例，肱骨内外侧髁骨折5例，肱骨小头软骨损伤17例，尺骨鹰嘴骨折2例，尺桡骨近端骨折2例。保守治疗33例，切开复位内固定26例，切除1例，假体置换1例。采用单因素相关分析显示：性别、年龄、侧别与伴发损伤的数量无相关性（P〉0．05），而桡骨头骨折的严重程度（Mason分型）与伴发损伤的发生具有正相关性（P〈0．05）；年龄、Mason分型、伴随损伤数量与治疗方式的选择具有相关性（P〈0．05）。结论Mason分型与伴发伤数量具有相关性，桡骨头骨折类型越严重，伴发损伤发生越多；年龄、Mason分型、伴发损伤数量对治疗方式的选择有影响。需要对桡骨头骨折的伴发损伤加以重视，治疗计划应当依据伴发损伤而定。

Objective To explore the relationship between a radial head fracture and its associated injuries and the effect of associated injuries on the treatment. Methods We retrospectively analyzed the patients with radial head fracture who had been treated from December 2013 to December 2015. The data of their gender, age, laterality, traumatic mechanisms, Mason classification of the fracture, associated injuries, and therapeutic methods were documented. Single factor correlation analysis was conducted to identify the relationship between Mason classification and number of associated injuries, and the effects of age, Mason classification and number of associated injuries on the therapeutic methods. Results The study cohort was comprised of 61 patients, including 32 men and 29 women with a male to female ratio of 1.1： 1. They were 20 to 78 years of age （average, 40 years） . Thirty-one cases had the left elbow affected, 29 the right elbow, and one bilateral elbows. There were 17 cases of Mason Type I, 30 ones of Mason Type 11, 9 ones of Mason Type Ⅲ, and 5 ones of Mason Type IV. Ligamentous injury was associated in 47 patients, coronoid fracture in 5, distal humeral fracture in 5, capitellum osteochondral defect in 17, oleeranon fracture in 2, and proximal radioulnar fracture in 2. Thirty-three patients had nonoperative treatment; 26 patients received open reduction and internal fixation; one patient underwent resection; radial head replacement was used in one. Single factor correlation analysis revealed no significant associations between number of associated injuries and gender, age, or laterality （ P 〉 0.05）, a positive correlation between severity of radial head fracture （Mason classification） and incidence of associated injuries （ P 〈 0. 05）, and significant relationships be- tween choice of therapy and age, Mason classification and number of associated injuries （ P 〈 0. 05） . Conclusions There may be a significant relationship between the Mason type and number of the associated injuries. The more severe a radial head fracture, the more associated injuries. Age, Mason classification, and number of associated injuries may affect the choice of therapeutic methods. In the treatment of radial head fractures, associated injuries must be considered carefully to minimize their impact. The therapy should de- pend on the associated injuries.