微型钢板、Herbert螺钉及可吸收棒内固定修复MasonⅡ型桡骨头骨折

Mini-plate, Herbert screw and absorbable rod in the internal fixation of Mason type Ⅱ radial head fractures

背景:可吸收材料是骨科新型的内固定材料,在临床的应用一直存在争议,但是可吸收材料可自行降解,避免二次手术创伤,在MasonⅡ型桡骨头骨折的治疗中有显著的优势。目的:探讨微型钢板、Herbert螺钉及可吸收棒3种内固定方式治疗MasonⅡ型桡骨头骨折的近期和远期疗效,为临床治疗提供指导。方法:收集大连医科大学附属第二医院关节外科于2010年3月至2016年2月收治的93例MasonⅡ型桡骨头骨折患者的临床资料,所有患者均行切开内固定,依据内固定方式的不同将患者分为微型钢板组21例、Herbert螺钉组39例、可吸收棒组30例,对比3组手术指标(手术时间及术中出血量)、骨折愈合时间及治疗费用,采用目测类比疼痛评估法、Broderg-Morrey肘关节功能评分评价患肢疼痛程度、肘关节功能,并记录3组手术不良反应情况。结果与结论:(1) 90例患者均获得术后2.2-8.2年随访,中位随访5.1年。各组患者手术时间、术中出血量、骨折愈合时间对比差异均无显著性意义(P> 0.05);(2)各组患者术后Broderg-Morrey评分随时间的推移均不断增高(P <0.05),各组间Broderg-Morrey评分优良率对比差异无显著性意义(P> 0.05);(3)各组患者术后目测类比评分随时间的推移逐渐降低(P <0.05),但可吸收棒组目测类比评分在术后3 d、1周、2周均低于微型钢板组和Herbert螺钉组(P <0.05);(4)各组不良反应率差异无显著性意义(P> 0.05);(5)微型钢板组及Herbert螺钉组治疗费用均高于可吸收棒组,差异均有显著性意义(P <0.05);(6)结果证实,与传统的微型钢板及Herbert螺钉内固定相比,可吸收棒内固定修复MasonⅡ型桡骨头骨折具有相似的疗效,但可有效缓解患者术后疼痛,不良反应少及治疗花费少的特点。

BACKGROUND:Absorbable material is a new type of internal fixation material in orthopedics,and its application is still a controversy in the clinic.Absorbable materials can degrade by themselves,and can avoid secondary trauma surgery,which exhibit a significant advantage in the treatment of Mason type II radial head fracture.OBJECTIVE:To explore the short-and long-term effects of the internal fixation using mini-plate,Herbert screw and absorbable rod in the treatment of Mason type II radial head fracture,and to provide guidance for clinical treatment.METHODS:The clinical data of 93 patients with Mason type II radial head fractures admitted at Department of Joint Surgery,the Second Hospital of Dalian Medical University from March 2010 to February 2016 were collected.All patients received incision and internal fixation surgery using mini-plate(21 cases),Herbert screw(39 cases)and absorbable rod(30 cases).The operative indexes(operation time,intraoperative blood loss),fracture healing time and treatment cost were compared.Visual Analogue Scale and Broderg-Morrey elbow function scores were recorded.The complications were evaluated.RESULTS AND CONCLUSION:(1)Ninety patients were followed up for 2.2-8.2 years,with an average of 5.1 years.There was no significant difference in the operation time,intraoperative blood loss or fracture healing time among groups(P>0.05).(2)The Broderg-Morrey scores postoperatively in each group were gradually increased with time(P<0.05),and the excellent and good rate of scores showed no significant difference among groups(P>0.05).(3)The postoperative Visual Analogue Scale scores in each group were gradually decreased with time(P<0.05).The scores in the absorbable rob group at 3 days,1 and 2 weeks postoperatively were significantly lower than those in the other two groups(P<0.05).(4)There was no significant difference in the adverse reaction rate among groups(P>0.05).(5)The treatment costs in the mini-plate and Herbert screw groups were significantly higher than those in the absorbable rod group(P<0.05).(6)Our findings suggest that absorbable rod for the repair of Mason type II radial head fracture has the similar effect with traditional mini-plate and Herbert screw,but it can effectively alleviate pain and reduce adverse reactions and treatment costs.