自体髂骨修复重建不可复位的桡骨头粉碎性骨折的临床疗效

Clinical effect of reconstructing irreducible comminuted radial head fracture with autogenous iliac bone graft

目的探讨自体髂骨修复重建不可复位的桡骨头粉碎性骨折的临床疗效。方法选取2016年6月—2019年6月昆明医科大学第四附属医院收治的MasonⅢ型及Ⅳ型桡骨头粉碎性骨折患者27例为研究对象,采用取自体髂骨修复重建桡骨头骨折的手术方式治疗,其术后均随访12个月以上。记录患者末次随访时的愈合情况、Broberg-Morrey肘部骨折疗效评分、上肢功能障碍评价表(DASH)评分,比较同一患者末次随访时患侧与健侧肘关节活动度。结果末次随访时X线片显示有25例患者桡骨头骨性愈合,骨性愈合率为92.6%,平均愈合时间(11.35±1.15)周。末次随访时Broberg-Morrey肘部骨折疗效评分优良率为88.9%,DASH评分平均(15.52±4.39)分。末次随访时同一患者的患侧肘关节屈伸、旋前及旋后活动度均低于健侧,差异有统计学意义(均P<0.05)。结论自体髂骨重建不可复位的粉碎性桡骨头骨折在短、中期内可获得满意疗效,远期疗效还有待进一步研究。

Objective To investigate the clinical effect of reconstructing irreducible comminuted radial head fracture with autogenous iliac bone graft.Methods A total of 27 patients with Mason typeⅢand typeⅣcomminuted radial head fracture admitted to the Fourth Affiliated Hospital of Kunming Medical University from June 2016 to June 2019 were selected as the research subjects.The comminuted radial head fractures were all surgically reconstructed with autogenous iliac bone.All patients were followed up for more than 12 months.Heal,Broberg-Morrey elbow fracture outcome score,and disability of arm,shoulder and hand scale(DASH)score were recorded at the last follow-up.The range of motion of the elbow of the affected side and the healthy side was compared in the same patient at the last follow-up.Results At the last follow-up,X-ray graphs showed that 25 patients had bony healing of the radial head.The bony healing rate was 92.6%,and the mean healing time was(11.35±1.15)weeks.At the last follow-up,the excellent and good rate of Broberg-Morrey elbow fracture outcome score was 88.9%,and the average DASH scale score was(15.52±4.39)points.At the last follow-up,the flexion and extension,pronation and supination range of motion of the elbow of the affected side was lower than that of the healthy side,and the differences were statistically significant(all P<0.05).Conclusion Reconstruction of irreducible comminuted radial head fractures with autogenous iliac bone graft can achieve satisfactory results in the short and medium term,but the long-term results need to be further studied.