切复内固定与置换治疗Mason III型桡骨头骨折的疗效对比

A comparison of the open reduction-internal fixation and arthroplasty techniques in treatment of Mason Type 3 radial head fractures

摘要:

【摘要】 目的 回顾性比较Mason III型桡骨头粉碎骨折进行切开复位内固定与置换的短中期疗效比较。方法 对2015年~2017年天津医院收治的不伴有脱位的粉碎性桡骨头骨折（Mason III型）患者52例进行术前行影像学检查，包括肘关节正侧位X线片，CT，MRI检查，以明确伴随损伤类型。对所有患者均采用肘关节后外侧入路（Kocher入路）进行手术并处理伴随损伤，26例采取切开复位内固定术，26例采取桡骨头置换术。术后采用Broberg—Morrey肘关节评分系统对肘关节功能进行评价，同时比较患者屈伸及旋转功能。结果 切开复位组，平均随访28.3±5.1个月，伴随其他损伤25例，B&M评分平均为78.0[69.8,81.5]分，优良率19.2%；置换组，平均随访27.4±4.1个月，全部伴随其他损伤，B&M评分平均为91.0[85.0,96.0]分，优良率100%，两组在伴随损伤，性别，年龄及随访时间上无显著性差异，在B&M评分及屈伸及旋转功能上存在显著性差异。结论 在Mason III型桡骨头的治疗中，桡骨头置换与切开复位内固定相比，能够获得更好的功能结果，出现更少的并发症。

Abstract:

[Abstract] Objective The aim of this study was to retrospectively compare a series of patients surgically treated with ORIF or prosthesis due to isolated comminuted radial head fractures. Methods From 2015 to 2017, 52 patients with isolated comminuted fractures of the radial head (Mason Type 3) had been operated (ORIF in 26 patients, Prosthesis in 26 patients) in our hospital. Preoperative imaging examinations, including anteroposterior and lateral X-ray of the elbow, and CT and MRI examination, were performed to identify the types of fracture and concomitant injury. The system of Broberg-Morrey，and range of motion (Flexion- Extension and Supination-Pronation) was used to evaluate the clinical results. Results: Open reduction group, with an average follow-up of 28.3±5.1 months, along with other damage of 25 cases, B&M score averaged 78.0points (69.8,81.5). excellent and good rate was 19.2%；Prosthesis groups, with an average follow-up of 27.4±4.1 months, all accompanied by other damage, B&M score averaged 91.0points (85.0,96.0), excellent and good rate was 100%. Two groups were no significant differences in concomitant injury, gender, age, and follow-up time. And We found a statistically significant difference between the ORIF and resection groups regarding the clinical outcomes. Conclusion: In Mason type III due to difficulty in achieving anatomical reduction results were not good with reconstruction when compared with prosthesis.