桡骨头骨折合并肘关节骨与韧带损伤诊治要点

Diagnosis and treatment of concomitant injury of bone and ligament of elbow joint with radial head fractures

目的探讨桡骨头骨折合并肘关节骨与韧带损伤的诊断与治疗方法。方法回顾性分析自2010-01—2016-01诊治的48例桡骨头骨折。7例体格检查提示肘关节稳定性好,行非手术治疗。41例行手术治疗,39例切开复位内固定,其中单纯无头空心钉内固定30例,微型钢板内固定9例;2例行桡骨头置换术。肱骨小头软骨碎屑清除6例,软骨摘除3例,螺钉固定1例。6例尺骨冠状突骨折行切开复位内固定术,其中套索缝线固定3例,锚钉固定1例,螺钉固定1例,微型钢板固定1例;2例未固定。10例外侧副韧带损伤用锚钉修复,4例内侧副韧带损伤用锚钉修复,3例内侧副韧带损伤未修复。结果 48例获得平均28.3(15~52)个月随访。骨折愈合时间平均6.4(6~8)周。末次随访时肘关节屈伸活动度平均135.3°(110°~143°),肘关节伸直受限平均5°(0°~15°),前臂旋转活动度平均145°(115°~160°)。末次随访时疗效采用Broberg-Morrey评分标准评定:优28例,良18例,差2例,优良率95.8%。结论复杂桡骨头骨折合并肘关节骨与韧带损伤较为常见,术前应完善常规检查,全面评估桡骨头骨折合并损伤的程度,并根据合并损伤特点制定合理的治疗方案,而早期准确的诊断和及时合理的治疗可提高临床疗效。

Objective To discuss the diagnosis and treatment of concomitant injury of bone and ligament of elbow joint with radial head fractures. Methods Fourty-eight patients with radial head fractures were treated from Jan. 2010 to Jan. 2016. Seven cases with good stability of elbow joint were treated with non-surgical operation. Forty-one cases were treated with surgical operation, 39 cases with open reduction and internal fixation, 30 cases with headless cannulated strew fixation, 9 cases with mini plate fixation. Two cases were treated with radial head replacement. Six cases were treated with removal of cartilage debris of capitulum humeri, 3 cases with removal of cartilage, and 1 case with screw fixation. Six cases of ulna coronoid process fractures were treated with open reduction and internal fixation, 3 cases with lasso suture fixation, l case with anchor fixation, 1 case with screw fixation, 1 case with mini plate fixation. Two cases of ulna coronoid process fractures were not fixed. Ten cases of lateral collateral ligament injury and 4 cases of medial collateral ligament injury were repaired with anchor, and 3 cases of medial collateral ligament injury were not repaired. Results The average follow-up time of the 48 cases was 28.3 months （range 15-52 months）. The average bone union time was 6.4 weeks （range 6-8 °eeks）. At the last follow-up, the average ulnohumeral motion was 135.3°（range 110°-143°）, the average extension loss was 5°（range 0°-15°）, and the average forearm rotation was 145°（range 115°-160°）. The curative effect was evaluated by Broberg-Morrey scoring system： excellent in 28 cases, good in 18 cases, poor in 2 cases, the excellent and good rate was 95.8%. Conclusion Complex radial head fractures are often combined with concomitant injury of bone and ligament of elbow joint. Routine examination should be improved before operation and the degree of concomitant injury with radial head fractures should be comprehensively evaluated. According to the characteristics of concomitant injury, a reasonable treatment plan is established. Early and correct diagnosis with timely and reasonable treatment can improve the clinical efficacy.