空心螺钉结合微钢板固定粉碎性桡骨小头骨折

Cannulated screws combined with mini plate for fixation of comminuted radial head fractures

摘要:

[目的] 探讨空心螺钉结合微型钢板固定粉碎性桡骨小头骨折的疗效。[方法] 回顾性分析 2022 年 2 月—2024 年 2 月本院收治的 100 例粉碎性桡骨头骨折患者的临床资料。根据医患沟通结果将患者分为两组，每组 50 例，联合组采用微型钢板结合空心螺钉治疗，单纯组仅采用微型钢板治疗，比较两组围手术期、随访及影像结果。[结果] 两组患者均顺利完成手术。联合组手术时间 [(55.3±5.0) min vs (58.2±5.2) min, P=0.040]、术中透视次数 [(5.2±1.1) 次 vs (8.7±1.3) 次, P＜0.001] 显著少于单纯组。患者均获随访，随访时间 12~16 个月，两组完全负重活动时间的差异无统计学意义 （P＞0.05）。随着时间推移，两组术后 VAS 评分、Broderg-Morrey 评分、肘关节伸-屈 ROM、前臂旋前-旋后 ROM 均显著改善 （P＜0.05）。术后 1 个月，联合组 Broderg-Morrey 评分 [(92.4±8.3) vs (87.2±7.8), P=0.021]、肘关节伸-屈活动度 [(118.6±6.7)° vs (111.6±6.0)°, P＜0.001]、前臂旋前-旋后活动度 [(142.6±7.9)° vs (135.2±7.2)°, P＜0.001] 显著优于单纯组，末次随访时，两组上述指标的差异均无统计学意义 （P＞ 0.05）。影像方面，联合组骨折复位质量 [优/良/差, (22/24/4) vs (14/23/13), P=0.037] 显著优于单纯组，两组不同时间骨折愈合比例差异无统计学意义 （P＞0.05）。相应时间点，两组提携角缩小、髁干角和 Baumann 角的差异均无统计学意义 （P＞0.05）。[结论]空心螺钉结合微型钢板可提高粉碎性桡骨头骨折患者临床效果，缩短手术时间、减少术中透视次数、提升骨折复位质量， 促进肘关节功能恢复。

Abstract:

[Objective] To explore the clinical efficacy of cannulated screws combined with mini plates in the treatment of comminuted radial head fractures. [Methods] A retrospective analysis was conducted on the 100 patients who had comminuted radial head fractures treated surgically in our hospital from February 2022 to February 2024. The patients were divided into two groups based on doctor-patient communication, with 50 cases in each group. The combined group was treated with cannulated screws combined with mini-plate, while the simple group was treated only with mini plate. The perioperative, follow-up and imaging documents of the two groups were compared. [Results] All patients in both groups were operated on successfully. The combined group proved significantly superior to the simple group in terms of operation time [(55.3±5.0) min vs (58.2±5.2) min, P=0.040] and intraoperative fluoroscopy times [(5.2±1.1) vs (8.7±1.3), P＜0.001]. All patients were followed up for 12 to 16 months. There was no statistically significant difference in the time to regain full weight-bearing activity between the two groups (P＞0.05). The VAS, Broderg-Morrey scores, as well as elbow extension-flexion range of motion (ROM) and forarm pronation-supination ROM in both groups were significantly improved over time (P＜0.05). The combined group proved significantly better than the simple group in terms of Broderg-Morrey score [(92.4±8.3) vs (87.2±7.8), P=0.021], elbow extension-flexion ROM [(118.6± 6.7)° vs (111.6±6.0)°, P＜0.001] and forarm pronation-supination ROM [(142.6±7.9)° vs (135.2±7.2)°, P＜0.001] one month after the operation, whereas which became not statistically significant between the two groups at the latest follow-up (P＞0.05). As for imaging, the combined group was marked significant better fracture reduction quality than the simple group [excellent/good/poor, (22/24/4) vs (14/23/13), P= 0.037]. However, there was no statistically significant difference in the proportion of fracture healing, the carrying angle, condylar angle and Baumann angle at the corresponding time points between the two groups (P＞0.05). [Conclusion] The cannulated screws combined with mini plate does improve the clinical outcome in the treatment of comminuted radial head fractures, shorten the operation time, reduce the number of intraoperative fluoroscopy, enhance the quality of fracture reduction, and promote the recovery of elbow function.