成人桡骨颈骨折手术与非手术远期疗效对比

Long Term Outcome of Nonoperative Treatment of Radial Neck Fractures in Adults

目的:探讨成人桡骨颈骨折非手术及手术治疗后的功能性远期疗效.方法:对2000年-2014年间治疗的34例平均年龄46.4岁(18.0-63.0岁)的桡骨颈骨折患者进行临床和放射学检查.非手术治疗20例,手术14例.结果:平均随访5.7年(2-15.7年),2组临床评分均良好.非手术组手臂、肩、手功能障碍评分为16.1(0-71.6)分,手术组为8.8(0-50.8)分.梅奥肘关节功能评分非手术组为80.0(30-95)分,手术组为82.5(35-95)分.手术组前后平面〔12.8°(2°-23°)vs 26.3°(1°-90°),P=0.015〕.在随访X线片中,手术组的RHSA(头对轴径向)显著降低〔15.1°(3°-30°)vs 10.9°(3°-18°),P=0.043〕.非手术组5例发生7种并发症,手术组7例发生12种并发症.非手术组1例行桡骨头切除术(5%),手术组7例(50%)需行翻修手术,手术组翻修率高.结论:成人桡骨颈骨折手术与非手术治疗均可获得良好的远期疗效.如果由于大移位而需要,切开复位与较高的并发症风险和翻修手术的需要相关,但是可以实现类似的临床结果.

Objective: The aim of this study is to determine the functional long - term outcome after non - operative and operative treatment of radial neck fractures in adults. Methods: Thirty - four consecutive patients with a mean age of 46. 4 (18.0 to 63. 0) years with a fracture of the radial neck who were treated between 2000 and 2014 were examined regarding the clinical and radiological outcome. Twenty patients were treated non - operatively, and 14 patients underwent surgery. Results: After a mean follow - up of 5. 7 (2. 0 to 15.7) years, the clinical scores showed good results in both groups. The Disabilities of Arm, Shoulder and Hand score was 16. 1 (0 to 71.6) in the non -operative group and 8. 8 (0 to 50. 8) in the operative group, respectively. The Mayo Elbow Performance Score was 80. 0 (30 to 95) in the non - operative group and 82. 5 (35 to 95 ) in the non - operative group, respectively. The initial angle of the radial head towards the shaft (RHSA) was significantly higher in the operative group in the anterior - posterior plane (12. 8°[2 to 23 ] vs. 26. 3°[ 1 to 90], p = 0. 015). In the follow - up radiographs, the RHSA was significantly lower in the operative group ( 15. 1°[3 to 30] vs. 10. 9°[3 to 18], p = 0. 043). Five patients developed 7 complications in the non -operative group, and 7 patients developed 12 complications in the operative group. Revision rates were higher in the operative groups as 1 patient received radial head resection in the non - operative (5%) group while 7 patients in the operative group ( 50%) needed revision surgery. Conclusion: A good functional long - term outcome can be expected after operative and non - operative treatment of radial neck fractures in adults. If needed due to major displacement, open reduction is associated with a higher risk of complications and the need for revision surgery but can achieve similar clinical results. Trial registration :DRKS DRKS00012836 ( retrospectively registered ).