劈指伸肌总腱入路治疗桡骨头骨折的疗效分析

Clinical outcome analysis on using extensor digitorum communis splitting approach for the treatment of radial head fractures

目的 :探讨劈指伸肌总腱入路治疗桡骨头骨折的临床疗效。方法 :回顾性分析自2012年7月至2015年5月收治的25例闭合桡骨头骨折患者资料,男17例,女8例;年龄20~67岁,平均39岁。所有患者使用劈指伸肌总腱入路暴露桡骨头骨折,其中钢板内固定重建21例,桡骨头置换4例。根据Mason分型:Ⅱ型19例,Ⅲ型6例。术后患者获临床随访和影像学评价直至骨折愈合及肘关节功能进入平台期。结果:25例均获随访,时间12~56个月,平均29个月。平均屈伸范围120°,伸直受限10°,屈曲135°;平均前臂旋转范围142°,旋前75°,旋后67°。末次随访时MEPI评分平均93±7(80~100分),其中19例功能为优,6例为良。根据Broberg和Morrey系统创伤性关节炎分级:0级19例,1级6例,无2、3级。无一例发生桡骨头骨折不愈合和内固定失败,未见神经、血管损伤并发症,无明显肘关节旋转功能受限。4例出现肘关节周围异位骨化,但活动无明显受限。4例桡骨头假体置换患者术后未见假体松动和感染等并发症发生。结论:劈指伸肌腱入路可以提供安全、可靠的桡骨头手术暴露路径,临床疗效满意。

Objective：To explore the clinical outcomes of internal fixation or replacement for the treatment of radial head fractures through the extensor digitorum communis splitting approach. Methods：From July 2012 to May 2015,25 patients with radial head fractures were reviewed. There were 17 males and 8 females,ranging in age from 20 to 67 years old,with a mean age of 39 years old. Twenty one patients were treated with reconstruction of plate internal fixation,and 4 patients were treated with radial head replacement. According to Mason classification,19 cases were type Ⅱ and 6 cases were type Ⅲ. All the patients underwent internal fixation or replacement through the extensor digitorum communis splitting approach. The patients were followed up clinically and radiographically until the beginning of fracture union and the entrance of function recovery of elbow motion into a plateau. The functional status of the elbow was evaluated using the Mayo Elbow Performance Index（MEPI）. Radiographic signs of post traumatic arthritis were rated according to the Broberg and Morrey system. Results：All the patients were followed up,and the average duration was 29 months（ranged,12 to 56 months）. The average range of flexion and extension was 120°,the extension was limited by 10°,and the flexion was 135°. The average forearm rotation range was 142°,pronation was 75°,supination was 67°. The mean MEPI was 93±7（ranged,80 to 100 scores）; according to the MEPI scoring criceria,19 patients got an excellent functional result,6 good. According to the Broberg and Morrey systems of traumatic arthritis,19 patients were in grade 0,6 in grade 1,and no patients in grade 2 or 3. No patients with nonunion of the radial head and failure of internal fixation were found. There were no complications of nerve or vascular injuries,and obvious limitation of elbow rotation. Heterotopic ossification around the elbow occurred in 4 cases,but the motion was not significantly limited. There were no complications such as prosthesis loosening and infection in 4 cases after radial head prosthesis replacement. Conclusion：The extensor digitorum communis splitting approach is an effective exposure method for internal fixation or replacement in the treatment of radial head fractures.