桡骨头骨折合并肱骨小头软骨损伤的临床特点

Clinical characteristics of radial head fracture combined with capitulum cartilage injury

目的探讨桡骨头骨折合并肱骨小头软骨损伤(CCI)的临床特点。方法回顾性分析2011年1月至2020年5月期间苏州大学附属无锡市第九人民医院骨科行手术治疗的110例桡骨头骨折患者资料。男62例,女48例;年龄17~74岁,平均44.1岁。按术中探查情况分为合并CCI组和非合并CCI组。主要观察合并组CCI的诊断、部位、大小、类型、手术方法和术后恢复等情况。比较两组患者术前一般资料、术前及末次随访时前臂活动范围和Mayo肘关节功能评分(MEPS)。结果合并CCI组25例,其中Ⅰ型7例,Ⅱ型12例,Ⅲ型6例,见于Mason各种桡骨头骨折类型;位于肱骨小头外侧13例,后外侧9例,前外侧3例。术前经局部麻醉后体检和影像学检查共诊断出CCI 13例,漏诊率48%(12/25)。合并CCI组术前屈伸(61.8°±13.7°)和旋转(60.0°±24.2°)范围小于非合并CCI组(77.7°±23.0°、79.9°±21.9°),桡骨头骨折Mason类型严重于非合并CCI组,差异均有统计学意义(P<0.05),而在年龄、性别、合并伤、桡骨头骨折处理方法、随访时间、末次随访时前臂活动范围和MEPS评分等方面,两组间比较差异均无统计学意义(P>0.05)。结论本研究桡骨头骨折合并CCI的发生率为22.73%(25/110),见于Mason所有桡骨头骨折类型,多发生在肱骨小头的外侧和后外侧影像学检查很容易漏诊。对于较轻桡骨头骨折怀疑合并CCI者,局部麻醉后体检阳性作为诊断合并CCI和手术指导的价值较大。桡骨头骨折手术中,应重视探查是否合并CCI。

Objective To characterize the radial head fracture combined with capitulum cartilage injury(CCI).Methods The data of 110 patients were analyzed retrospectively who had been treated for radial head fracture at Department of Orthopaedics,The Ninth People's Hospital of Wuxi from January 2011 to May 2020.They were 62 males and 48 females,aged from 17 to 74 years(average,44.10 years).According to the finding of intraoperative exploration whether CCI was complicated or not,they were assigned into a CCI group and a CCI-free group.The diagnosis,location,size,type,operation method and postoperative recovery of CCI were observed in CCI group.The 2 groups were compared in terms of preoperative general data,range of forearm motion before and after operation and functional recovery of the limb by Mayo elbow performance score(MEPS).Results CCI was complicated in 25 cases(typeⅠin 7 ones,typeⅡin 12 ones and typeⅢin 6 ones),involving all Mason types of radial head fracture,and located at the lateral capitellum in 13 cases,at the posterolateral capitellum in 9 cases and at the anterolateral capitellum in 3 cases.CCI was diagnosed before operation in 13 cases by physical examination after local anesthesia and imaging examination with a rate of 48%(12/25)for missed diagnosis.The preoperative flexion and extension(61.8°±13.7°)and rotation(60.0°±24.2°)in CCI group were significantly less than those in CCI-free group(77.7°±23.0°and 79.9°±21.9°)(P<0.05);the Mason types of radial head fracture in CCI group were significantly more serious than those in CCI-free group(P<0.05).There was no significant difference between the 2 groups in age,gender,combined injury,treatment of radial head fracture,follow-up time,range of forearm motion at the last follow-up or MEPS score(P>0.05).Conclusions CCI was complicated in 22.73%(25/110)of the radial head fractures in this cohort and found in all Mason types of radial head fracture,and mostly located at the lateral and posterolateral capitellum.CCI is likely to be missed by imaging examination.In patients with mild radial head fracture and suspected CCI,positive physical examination after local anesthesia is valuable for diagnosis of CCI complication and operative indication.Care should be taken to detect CCI complication by intraoperative exploration in surgery of radial head fracture.