切开复位内固定与假体置换治疗MasonⅢ、Ⅳ型桡骨小头骨折的疗效比较

Comparison of the Efficacy of Incisional Internal Fixation and Prosthetic Replacement in the Treatment of Mason TypeⅢandⅣRadial Tuberosity Fractures

目的通过比较切开复位内固定与假体置换治疗MasonⅢ、Ⅳ型桡骨小头骨折的疗效,为该类型骨折的临床治疗提供依据。方法选取我院2017年11月至2022年7月Mason分型符合Ⅲ、Ⅳ型的桡骨小头骨折成年患者64例,采用Quick DASH问卷得分及Broberg和Morrey肘关节功能评分比较切开复位内固定与假体置换两种治疗方式术后患肢的残疾分度、肘关节功能。结果Quick DASH问卷得分比较发现,内固定组与置换组的总残疾分度没有差异(P=0.524);且术后3个月~1年的患者,内固定组与置换组的患肢残疾分度没有差异(P=0.315);术后1~3年的患者,内固定组与置换组的患肢残疾分度也没有差异(P=0.693)。Broberg和Morrey肘关节功能评分比较发现,内固定组比置换组的肘关节功能好(P=0.04);而内固定组与置换组术后3个月~1年,患者的肘关节功能相当(P=0.315);术后1~3年的患者,内固定组与置换组肘关节功能也相同(P=0.693)。结论(1)对于MasonⅢ、Ⅳ型桡骨小头骨折的治疗,与桡骨小头置换术相比,切开复位内固定同样能重拾患者的肘关节功能,且术后3个月~1年就能达到与假体置换相当的功能。(2)切开复位内固定与桡骨头置换术的Broberg和Morrey肘关节功能评分的轻度差异,并不影响患肢的残障分度,因此Quick DASH问卷得分更能体现肘关节功能对患者生活的影响,更能客观评价肘关节的临床疗效。

Objective Comparison of the efficacy of incisional internal fixation and prosthesis replacement in the treatment of MasonⅢandⅣradial tuberosity fractures to provide a basis for the clinical treatment of this type of fracture.Methods Sixty-four adult patients with radial tuberosity fractures conforming to Mason's staging typeⅢandⅣfrom November 2017 to July 2022 in our hospital were included,and the Quick DASH questionnaire score and Broberg and Morrey elbow function score were used to compare the disability score and elbow function of the affected limb after surgery with both incisional internal fixation and prosthetic replacement.Results Comparison of the Quick DASH questionnaire scores showed that there was no difference in the total disability score between the internal fixation group and the replacement group(P=0.524);and there was no difference in the disability score of the affected limb between the internal fixation group and the replacement group for patients 3 months to 1 year postoperatively(P=0.315);and there was no difference in the disability score of the affected limb between the internal fixation group and the replacement group for patients 1 year to 3 years postoperatively(P=0.693).The comparison of the functional scores of Broberg and Morrey elbow joints revealed that,the elbow joint function in the internal fixation group was better than in the replacement group(P=0.04);while the elbow joint function of patients in the internal fixation group and the replacement group was comparable from 3 months to 1 year after surgery(P=0.315);the elbow joint function of patients in the internal fixation group and the replacement group was also the same from 1 year to 3 years after surgery(P=0.693).Conclusion In the treatment of Mason typeⅢandⅣradial tuberosity fractures,compared to radial tuberosity replacement,incisional internal fixation can also restore the patient's elbow function and achieve function equivalent to that of prosthetic replacement in 3 months to 1 year after surgery.The mild difference in the Broberg and Morrey elbow function score between incisional internal fixation and radial head replacement does not affect the disability score of the affected limb,so the Quick DASH questionnaire score better reflects the impact of elbow function on patients'lives and more objectively evaluates the clinical outcome of the elbow joint.