创伤骨科医生对Mason Ⅱ型桡骨头骨折诊治现状的调查研究

A survey on the diagnosis and treatment of Mason Type Ⅱ radial head fracture by domestic orthopaedic trauma surgeons in China

目的调查国内骨科医生诊治Mason Ⅱ型桡骨头骨折时的主要考虑因素。方法于2022年1月15-16日采用便利抽样的调查方法对全国创伤骨科医生进行问卷调查,调查内容包括医生的基础信息、医生对Mason Ⅱ型桡骨头骨折的评估、医生的治疗倾向及认可的手术适应证等。结果共获得474份有效问卷。358名医生(75.5%,358/474)认为Morrey等改良的Ⅱ型桡骨头骨折分型能够很好地指导治疗,460名医生(97.0%,460/474)认为需要联合肘关节X线片和CT检查诊断骨折情况。青年(80.2%,380/474)、优势侧受累(66.2%,314/474)、合并同侧上肢损伤(78.7%,373/474)、骨折移位大(67.7%,321/474)、骨折块与主骨分离(91.6%,434/474)以及骨折受累面积>30%(81.6%,387/474)是创伤骨科医生选择手术治疗时主要考虑的因素。骨折移位大(71.7%,340/474)特别是关节面台阶移位大(83.5%,443/474)、骨折块与主骨分离(75.9%,360/474)以及查体发现前臂旋转受限或关节弹响(82.7%,392/474)是创伤骨科医生较为认可的Mason Ⅱ型骨折的手术指征。结论对于存在骨性分离、骨折移位大,特别是关节面台阶大的桡骨头Mason Ⅱ型骨折患者,医生更倾向选择手术治疗。

Objective To investigate the major considerations of domestic orthopaedic trauma surgeons in China when they diagnose and treat Mason type Ⅱ radial head fractures.Methods A questionnaire survey was conducted from January 15,2022 to January 16,2022 using the convenience sampling method among domestic orthopedic trauma surgeons in China.The survey covered the surgeons'basic information,evaluation of Mason type Ⅱ radial head fractures,treatment preferences,and surgical indications recognized.Results The present survey retrieved 474 eligible questionnaires.358 surgeons(75.5%,358/474)believed that the Morrey modified classification for Mason type Ⅱ radial head fracture could properly guide their diagnosis and treatment.460 surgeons(97.0%,460/474)believed that diagnosis of the fracture should be based on a combination of elbow X-ray and elbow CT examinations.Young age(80.2%,380/474),dominant side involvement(66.2%,314/474),concomitant ipsilateral upper limb injury(78.7%,373/474),large fracture displacement(67.7%,321/474),separation of fracture fragments from the main bone(91.6%,434/474),and fracture involvement area>30%(81.6%,387/474)were the main factors considered by the orthopedic trauma surgeons when they chose surgical treatment.Large fracture displacement(71.7%,340/474),especially large articular steps(83.5%,443/474),separation of fracture fragments from the main bone(75.9%,360/474),and limited forearm rotation or joint clicking(82.7%,392/474)found during physical examination were recognized as surgical indications for Mason typeⅡfracture by orthopedic trauma surgeons.Conclusion Domestic orthopedic trauma surgeons in China prefer surgical treatment for Mason type Ⅱ radial head fractures with loss of cortical contact and large displacement,especially large articular steps.