个体化微型重建钛板在桡骨头骨折内固定治疗中的临床应用

Application of individualized micro reconstruction plate in internal fixation of radial head fracture

目的 探讨个体化微型重建钛板在MasonⅡ、Ⅲ型桡骨头骨折内固定治疗中的应用效果。方法 选取2016年3月至2021年3月在首都医科大学附属北京天坛医院接受内固定手术治疗的桡骨头骨折患者90例,按Mason分型分为Ⅱ型组(24例)与Ⅲ型组(66例),均采用微型重建钛板根据骨折部位个体化塑形后进行内固定治疗。术后随访12~18个月,平均(14.5±3.7)个月。术后1、3、12个月测定患侧肘关节屈伸活动度和前臂旋转活动度,术后12个月采用Mayo肘关节功能评分(Mayo elbow performancescore,MEPS)和上肢功能障碍(disabilitiesofthearm,shoulderandhand,DASH)评分评定患侧肘关节功能。结果 所有患者手术顺利,无感染、神经损伤、创伤性关节炎、异位骨化、肘关节失稳、内固定松动断裂等并发症发生。术后1个月两组健侧肘关节屈伸活动度及前臂旋转活动度明显优于患侧,差异有显著性(P<0.05),而术后3个月、12个月时两组健侧与患侧的肘关节屈伸活动度及前臂旋转活动度比较差异已无显著性(P>0.05)。术后12个月所有患者患侧MEPS评分均为优良,患侧MEPS评分及DASH评分与健侧比较差异无显著性(P>0.05),Ⅱ型组患侧MEPS评分及DASH评分与Ⅲ型组比较差异亦无显著性(P>0.05)。结论 采用个体化微型重建钛板治疗桡骨头骨折可获得良好疗效,具有塑形简单、体积小、术中组织剥离少、术后对肘关节活动影响小且费用适宜等优点,值得临床应用。

Objective Illustrating the effect and advantages of individualized micro reconstruction plates in internal fixation of MasonⅡandⅢradial head fractures.Method Ninety patients with radial head fractures who were operated in our department from March 2016 to March 2021 were collected.According to Mason classification,there were 24 cases of typeⅡ,66 cases of typeⅢ.All patients were open reduction internal fixation with individualized micro reconstruction plates according to the fractures position.The average follow-up time was 14.5 months(12-18 months).According to the flexion and extension range of elbow joint and forearm rotation range of affected side 1 month,3 months and 12 months post-operation,EMPS and DASH,the function of elbow joint was compared between affected side and healthy side after surgery by paired t test 12 months post-operation.The chi-square test was used to compare the quality of postoperative limb with anatomical locking titanium plate.Result The Mayo score of this group of patients after surgery was excellent,without infection,nerve injury,traumatic arthritis,ectopic ossification,elbow joint instability,internal fixation loosening and fracture,and other complications.There was no statistically significant difference in postoperative elbow joint function between the affected side and the healthy side(P>0.05).The flexion and extension motion of the elbow on the affected side and the rotational motion of the forearm on the healthy side had statistical significance one month after the operation(P<0.05),but no statistical significance was found at 3 months and 12 months after the operation(P>0.05).There was no significant difference between Mayo elbow function score and DASH upper limb function score 12 months after surgery in typeⅡandⅢpatients(P>0.05),and there was no significant difference between the superior elbow function rate of the affected limb and the reported efficacy of anatomic locking titanium plate(P>0.05).Conclusion Treatment of radial head fractures with individualized micro reconstruction plates can obtain good curative effect,and it has the advantages of individuation,shaping conveniently,small thickness,minimal invasive,little influence on elbow joint movement postoperation and cheapness.