肱桡关节"接吻骨折"——桡骨头骨折伴肱骨小头骨折的临床特点分析

Clinical characteristics of concomitant fractures of the radial head and humeral capitellum

目的探讨桡骨头骨折伴肱骨小头骨折的临床特点。方法回顾分析我科自2015年1月至2022年8月收治的316例桡骨头骨折或肱骨小头骨折患者资料,其中同侧伴发骨折12例(伴发组),非伴发304例(单一组)。主要分析伴发组的临床特点,其次比较伴发组与单一组术前一般资料、桡骨头骨折类型、合并伤、治疗方法、治疗前后肘关节活动范围、随访时间、肢体功能恢复和并发症等方面的差异。桡骨头骨折和肱骨小头骨折分别按Mason和Grantham进行分型。采用Mayo肘关节功能评分标准评价患肢功能。结果桡骨头骨折MasonⅠ至Ⅳ型分别为2例、7例、2例和1例,肱骨小头骨折GranthamⅠ至Ⅲ型分别为10例、2例和0例。常规X线检查漏诊4例,均为Ⅰ型骨折,1例经桡骨头-肱骨小头位摄片、3例经CT检查获确诊。伴发组保守治疗1例,手术治疗11例;手术治疗患者中,桡骨头骨折均内固定,肱骨小头骨折内固定9例、保守治疗2例。所有骨折均愈合。随访时间为12~23个月,末次随访时Mayo肘关节功能评分恢复到89.7±7.9,优8例、良2例、可2例,2例并发肘关节活动受限。伴发组伤后肘关节活动范围小于单一组,手术率高于单一组,差异有统计学意义(P<0.05),但伴发组与单一组在年龄、性别、病因、合并韧带伤、桡骨头骨折类型、随访时间、末次随访肘关节活动范围、Mayo肘关节功能评分和并发症等方面比较,差异无统计学意义(P>0.05)。结论桡骨头骨折伴肱骨小头骨折临床少见,轻微骨折常规X线检查易漏诊,需要行桡骨头-肱骨小头位摄片或CT才能明确诊断;大多数患者的桡骨头骨折较肱骨小头骨折严重;与单一骨折相比,伴发骨折患者症状较重、手术率较高,但总体治疗效果满意。

Objective To investigate the characteristics of concomitant fractures of the radial head and humeral capitellum.Methods The data of 316 patients with radial head or humeral capitellum fractures from January 2015 to August 2022 were retrospectively analyzed.There were 12 cases of concomitant fractures of the radial head and humeral capitellum(concomitant group)and 304 cases were non concomitant fractures(single fracture group).The clinical characteristics of the concomitant group were the primary objective,and the preoperative general data,type of radial head fractures,treatment methods,range of motion of elbow joint after injury and at follow-up,follow-up time,limb function recovery and complications were compared between the two groups.The radial head fractures and humeral capitellum fractures were classified by Mason and Grantham,respectively.Limb function was assessed using the Mayo Elbow Score(MEPS).Results In the concomitant group,Mason typeⅠtoⅣof the radial head fractures were 2 cases,7 cases,2 cases and 1 case respectively,and Grantham typeⅠtoⅢof the humeral capitellum fractures were 10 cases,2 cases and 0 case respectively.4 cases with typeⅠwere missed in diagnosis by route X-ray examination,all of which were typeⅠfractures.1 case was confirmed by radial head-capitellar view and 3 cases by CT.1 case was treated conservatively in the concomitant group,and 11 cases were treated surgically.Among the patients undergoing surgical treatment,all radial head fractures were treated with internal fixation,with 9 cases of the humeral capitulum fractures treated with internal fixation and 2 cases treated with conservative treatment.All fractures have healed.The follow-up period was 12 to 23 months.At the last follow-up,the MEPS recovered to 89.7±7.9.The results were excellent in 8 cases,good in 2 cases,fair in 2 cases.2 cases were complicated with limited elbow joint movement.The range of elbow joint activity in the concomitant group was smaller than that in the single fracture group,and the surgical rate was higher than that in the single fracture group,with statistical significance(P<0.05).However,there was no statistically significant difference between the concomitant group and the single fracture group in terms of age,gender,etiology,combined ligament injury,type of radial head fracture,follow-up time,last follow-up range of elbow joint activity,MEPS,and complications(P>0.05).Conclusion The radial head fracture accompanied by humeral capitellum fracture is relatively rare in clinical practice.The patients with mild injuries are prone to missed diagnosis through routine X-ray examination,and require radial head-capitellar view or CT to make a clear diagnosis.In the vast majority of patients,radial head fractures are more severe than humeral capitellum fractures.Compared with single fracture patients,the concomitant patients have more severe symptoms and high operation rate,but its overall clinical efficacy was satisfied.