桡骨头骨折块体积与手术方法的相关性

Fragment volume and surgical methods in radial head fracture

目的探讨桡骨头骨折患者的骨折块体积与手术方法的相关性。方法回顾性分析2013年1月至2016年12月华中科技大学同济医学院附属普爱医院手外科收治的60例MasonⅢ型桡骨头骨折患者资料。男28例,女32例;年龄26~71岁,平均54.5岁。41例患者行切开复位内固定术(切开组),19例患者行桡骨头置换术(置换组);术前通过肘关节CT平扫+三维重建,测量桡骨头体积和骨折块体积,并计算出相应的加权比值(R)。对桡骨头骨折块加权比值(R)与Broberg-Morrey肘关节功能评分进行相关性研究。末次随访时采用Broberg-Morrey肘关节功能评分评定疗效,并记录两组患者的并发症情况。结果60例患者术后获20~36个月(平均28.6个月)随访。末次随访时切开组和置换组患者Broberg-Morrey肘关节功能评分分别为(86.5±1.3)分(72~91分)、(93.6±1.4)分(78~95分);并发症发生率分别为17.1%(7/41)、15.8%(3/19)。切开组患者桡骨头骨折块体积加权比值R和肘关节Broberg-Morrey评分之间存在线性关系,两者之间的线性回归方程为:y=65.63+0.67x(R^2=0.85,P=0.0006)。置换组患者桡骨头骨折块体积加权比值R和肘关节Broberg-Morrey评分之间不存在线性关系(P=0.053)。将置换组Broberg-Morrey肘关节功能评分(93.6分)代入线性回归方程y=65.63+0.67x,即y=93.6时,x=41.7。结论桡骨头骨折块体积比≥41.7的MasonⅢ型骨折患者行切开复位内固定术预后较好;桡骨头骨折块体积比<41.7的MasonⅢ型骨折患者行桡骨头置换术效果较好;对于伴有骨质疏松的老年患者,行桡骨头置换预后较好。

Objective To investigate the relationship between volume of fracture fragment and surgical methods in patients with radial head fracture.Methods A retrospective study was conducted of the 60 patients with radial head fracture of Mason typeⅢwho had been admitted to the Department of Hand Surgery,Wuhan Pu'ai Hospital from January 2013 to December 2016.They were 28 males and 32 females,aged from 26 to 71 years(average,54.5 years).Of them,41 underwent open reduction and internal fixation(incision group)and 19 radial head replacement(replacement group).The volumes of radial head and fracture fragment were measured by CT scan and three-dimensional reconstruction of the elbow joint before operation.A volume-weighted ratio R corresponding to a specific radial head fragment was calculated.Correlation between the volume-weighted ratio R of the radial head fragment and the Broberg-Morrey elbow function score was calculated.At the last follow-up,the Broberg-Morrey elbow function score was used to assess the efficacy and complications were recorded in the 2 groups.Results All the 60 patients were followed up for 20 to 36 months(mean,28.6 months).At the last follow-up,the Broberg-Morrey elbow function score was 86.5±1.3 points(from 72 to 91 points)for the incision group and 93.6±1.4 points(from 78 to 95 points)for the replacement group;the complication rate was 17.1%(7/41)for the former and 15.8%(3/19)for the latter.There was a linear relationship between the volume-weighted ratio R of the radial head fragment and the Broberg-Morrey elbow function score in the incision group.The linear regression equation between the two was:y=65.63+0.67x(R2=0.85,P=0.0006).There was no linear relationship between the volume-weighted ratio R of the radial head fragment and the Broberg-Morrey elbow function score in the replacement group(P=0.053).When the Broberg-Morrey elbow joint function score(93.6 points)for the replacement group was substituted into the linear regression equation y=65.63+0.67x(y=93.6),x=41.7.Conclusions In the patients with radial head fracture of Mason typeⅢ,open reduction and internal fixation may lead to a better prognosis for those with a volume ratio≥41.7 between the radial head and fracture fragment while radial head replacement may lead to a better prognosis for those with a volume ratio<41.7 between the radial head and fracture fragment and for those elderly ones with osteoporosis.