应用桡骨头置换治疗复杂肘关节骨折脱位的疗效评价

Clinical effect of radial head replacement for complex elbow joint fracture and dislocation

目的评价桡骨头置换治疗成人复杂肘关节骨折脱位的临床效果。方法回顾性分析2016年7月至2020年6月于宁波市第六医院骨科行桡骨头置换术的成人复杂肘关节骨折脱位患者资料共45例;其中男25例,女20例;平均年龄为51.9(25~76)岁;右侧23例,左侧22例;包括高处坠落15例、交通伤17例、平地摔伤l3例。对比患者术前、术后疼痛视觉模拟评分(VAS)。记录患侧末次随访Mayo肘关节功能评分,与健侧对比并评价。结果所有患者术后均获得平均随访15.3(12~22)个月。术后VAS明显优于术前[(1.6±0.7)分比(5.8±1.5)分](P<0.05)。末次随访时患侧Mayo肘关节功能评分各项指标及总分虽未达到健侧水平(P<0.05),但患侧优良率达82.2%(37/45)。随访期间发生轻度异位骨化4例、创伤性关节炎5例、肘关节僵硬3例。患者症状轻而未予手术干预。尺神经症状2例,随访期间症状恢复。未出现肘关节感染、假体松动、强直、脱位等并发症。结论桡骨头置换术应用于伴有粉碎性桡骨头骨折的复杂肘关节骨折脱位,并发症较少,术后关节功能恢复良好。

Objective To evaluate the clinical effect of radial head replacement in adult complicated elbow joint fracture and dislocation.Methods The data of 45 adult patients with complex elbow joint fracture and dislocation who underwent radial head replacement were retrospectively analyzed in Department of Orthopaedics,the Sixth Hospital of Ningbo,from July 2016 to June 2020.There were 25 males and 20 females;mean age was 51.9(25-76)years.There were 23 cases on the right side and 22 on the left side.Causes of injury included 15 cases of falling from high places,17 cases of traffic injuries,l3 cases of flat falls.The visual analogue scale(VAS)of preoperative and postoperative pain was compared.The Mayo elbow function score of the affected side was recorded at the last follow-up,and compared with that of the healthy side.Results All patients were followed up for mean 15.3(12-22)months.The postoperative pain score was(1.6±0.7),which was significantly better than the preoperative pain score(5.8±1.5)(P<0.05).Although the indicators and total score of Mayo elbow joint function score on the affected side did not reach the level of the healthy side at the last follow-up(P<0.05),but the excellent and good rate of the affected side was 82.2%(37/45).There were 4 cases of mild ectopic ossification,5 cases of traumatic arthritis,and 3 cases of elbow stiffness during the follow-up.Ulnar nerve symptoms were recovered in 2 cases during follow-up.There were no complications such as elbow infection,prosthesis loosening,stiffness and dislocation.Conclusion Radial head replacement could be applied to the complicated elbow joint fracture and dislocation with comminuted radial head fracture.The postoperative joint function recovery is good,with few complications.