桡骨头前缘骨折合并肘关节外侧韧带复合体损伤的临床疗效

Clinical efficacy of anterior radius head fracture combined with lateral ligament complex injury

目的探讨桡骨头前缘骨折合并肘关节外侧韧带复合体损伤的临床疗效。方法回顾性分析2017年9月至2021年8月收治的105例桡骨头前缘骨折患者的病历资料,男51例、女54例,年龄(38.84±13.63)岁(范围16~70岁)。基于Mason分型Ⅱ型桡骨头骨折的基础上,对单纯累及桡骨头前缘的病例,按照骨折块数量及移位类型,将桡骨头前缘骨折分为三个亚型:A型,桡骨头前缘一部分塌陷骨折,53例;B型,桡骨头前缘两部分及以上塌陷骨折,50例;C型,桡骨头前缘分离移位骨折,2例。所有类型骨折均行骨折切开复位内固定术,其中B型骨折肘关节外侧韧带复合体损伤拉长但连续性存在,早期的21例未行加强修复(未修复组)、后期的29例采用肘关节外侧韧带复合体加强修复(修复组)。采用肘关节活动范围、撑桌试验、Mayo评分、Broberg Morrey评分评价术后疗效。撑桌试验按照实际完成时间记录,其余观察指标均于末次随访时进行评估。结果所有手术均顺利完成,随访时间为(14.08±1.52)个月(范围12~18个月)。A型骨折肘关节屈伸范围为115.7°±6.4°,撑桌试验完成时间为第(75.68±11.90)天,Mayo评分为(93.72±2.40)分,Broberg Morrey评分为(92.89±2.28)分。B型骨折中修复组肘关节屈伸活动范围为112.1°±4.4°,优于未修复组的105.8°±3.7°(t=5.31,P<0.001);修复组撑桌试验完成时间为第(77.72±6.51)天,早于未修复组的第(104.29±18.45)天(t=6.32,P<0.001);修复组Mayo评分为(90.21±5.88)分,与未修复组(87.14±5.26)分的差异无统计学意义(t=1.90,P=0.063);修复组Broberg Morrey评分为(90.93±6.43)分,高于未修复组的(86.95±6.37)分(t=2.17,P=0.035)。C型骨折肘关节屈伸活动范围分别为107°、106°;撑桌试验分别为第82天及第98天;Mayo评分分别为91分、87分;Broberg Morrey评分分别为93分、85分。B型骨折未修复组出现异位骨化伴肘关节僵硬1例。结论桡骨头前缘A型骨折肘关节稳定,无外侧韧带复合体损伤;B型骨折因外侧韧带复合体损伤拉长使肘关节存在失稳,建议一期进行修复;C型骨折合并外侧韧带复合体断裂,应一期进行修复。

Objective To investigate the operation efficacy of anterior radius head fracture combined with lateral ligament complex injury.Methods The patients with radial head fracture admitted from September 2017 to August 2021 were retrospectively analyzed,51 males and 54 females,average age of 38.84±13.63 years(range of 16-70 years).Based on the radial head fractures of Mason classification of type II,the cases involving the anterior radius head fracture were divided into three subtypes according to the number of fracture blocks and the type of displacement:type A(53 cases):one part of the anterior radius head collapse fracture;type B(50 cases):two or more parts of the anterior radial head collapse fracture;type C(2 cases):anterior radius head dissociated and displaced fracture.All fractures were treated with open reduction and internal fixation.Among them,the lateral ligament complex of type B were elongated due to the injury but the continuity existed.Therefore,the lateral ligament complex in 21 cases were not repaired in the early period(unrepaired group);in recent years,29 cases repaired the lateral ligament complex(repair group).The postoperative efficacy was evaluated by elbow range of motion,table-top relocation test,Mayo score,and Broberg Morrey score.the patients were evaluated at final follow-up,except table-top relocation test was recorded according to the actual completion time.Results All operations were successfully completed.The mean follow-up was 14.08±1.52 months(range of 12-18 months).Type A:the flexion and extension range was 115.70°±6.35°;the completion time of the table-top relocation test was 75.68±11.90 days;the Mayo score was 93.72±2.40 point,and the Broberg Morrey score was 92.89±2.28 point.Type B:lateral ligament repair group(repaired group)29 cases and unrepaired lateral ligament group(unrepaired group)21 cases.The flexion and extension range of elbow in repaired group was 112.1°±4.4°,which was better than that in unrepaired group 105.8°±3.7°(t=5.31,P<0.001).The completion time of table-top relocation test was 77.72±6.51 days in repaired group and 104.29±18.45 days in unrepaired group(t=6.32,P<0.001).The Mayo score of the repaired group was 90.21±5.88 points and that of the unrepaired group was 87.14±5.26 points(t=1.90,P=0.063),and there was no significant difference between the two groups.Broberg Morrey score of 90.93±6.43 points in the repaired group was better than 86.95±6.37 points in the unrepaired group(t=2.17,P=0.035).Type C for 2 patients,the flexion and extension range of elbow were 107°and 106°;the completion time of table-top relocation test were 82 days and 98 days;the Mayo scores were 91 point and 87 point;Broberg Morrey scores were 93 point and 85 point.There was a patient developed myositis ossificans in unrepair group of tybe B.Conclusion The elbow joint is stable when one part of the anterior radius head collapse fracture;there is a degree of instability in the elbow when two or more parts of the anterior radial head collapse fractures suggest to repair the lateral ligament complex.The elbow joint is extremely unstable when anterior radius head dissociated and displaced fractures,the lateral ligament complex should be repaired in time.