摘要
目的探讨保守治疗无骨性阻挡的MasonⅡ、Ⅲ型桡骨头骨折的疗效。方法回顾性分析2009年1月至2016年3月，治疗42例无骨性阻挡的Masonll、m型单纯桡骨头骨折患者资料，男20例，女22例；年龄15～51岁，平均（32．32±13．62）岁；左侧18例，右侧24例；Masonll型33例，Ⅲ型9例。首次就诊时间在伤后3d以内。应用短期制动结合早期功能锻炼方法进行治疗，同时配合口服镇痛药物以减轻患者疼痛，使视觉模拟评分（visual analogue scale，VAS）在3分以下，允许主动活动结合轻柔的被动活动行肘关节屈伸和前臂旋转的全范围活动。结果42例患者均获得随访，随访时间4~82个月，平均（35．13±8．56）个月。其中37例患者在治疗后约2个月肘关节功能即基本恢复正常，5例在末次随访时伸肘受限〈30°，屈肘和旋转未受限，对日常生活和工作无明显影响。42例患者末次随访时，屈肘130°～140°，平均136．260±5．43°；伸肘受限30°～过伸10°，平均3．36°±14．13°；屈伸活动范围100°～150°，平均133．25°±16．43°；前臂旋前80°～90°，平均87．67°±6．32°；旋后均可达到平均90°；前臂旋转活动范围170°～180°，平均177．630±5．390；Mayo肘关节功能评分（Mavoel—bow performance score，MEPS）均可达100分，优良率100％。末次随访时，无一例发现桡骨头骨折移位增加，且活动范围恢复后无明显疼痛；x线片均示桡骨头愈合于非正常解剖位置，但均未见骨折不愈合、缺血性坏死和关节退变。结论在缓解疼痛的状态下对无骨性阻挡和分离移位的MasonⅡ、Ⅲ型桡骨头骨折，即使伴严重粉碎和塌陷，也可选择短时制动和合理的功能锻炼进行治疗，保守治疗后肘关节功能可恢复或接近正常，不会发生骨折不愈合、缺血坏死、关节退变等并发症。
Objective To diseuss the efficacy of conservative treatment for Mason II and III type of radial head fracture without bony block. Methods From January 2009 to March 2016, 42 patients with type II and type III radial head fractures but no bony block were included, and there were 20 males and 22 females, 18 eases on the left side and 24 eases on the right side. The average age was 32.32±13.62 （range, 15-51） years old. Mason type II were in 33 eases, while type Ⅲ 9 cases. All were treated by short-time immobilization combined with early functional exercise. When taking exercise, oral analgesics were used to relieve pain to less than 3 points of visual analogue scale （VAS） which allowing active activities eombined with gentle passive activities to reach full range of motion. Results The average follow-up time was 35.13±8.56 （range, 4-82） months. 37 patients had a normal function 2 months after injury, while 5 eases had extension limitation at final follow-up, but less than 30°, without flexion and rotation restriction, no influence on daily life and work. Mean flexion was 136.26°±5.43° （range,130°- 140°）; mean extension was 3.36°±14.13° （range, 30°-overextension 10°）; average flexion and extension ROM was 133.25°±16.43° （range, 100°- 150°）; average pronation was 87.67°±6.32°（range, 80°- 90°）; mean supination was 90°; average rotation range of motion 177.63°±5.39°（range, 170°- 180°）; Mayo elbow performance score （MEPS） was 100 points, and the excellent and good rate 100%. No obvious symptoms of pain were found. There were no nonunion, avascular necrosis and joint degeneration. Conclusion By pain relief and strict examination of patients with Mason II and IIIype of radial head fracture to determine whether there is bony block, if there is, the patients have to be treated surgically, if there is no bony block and separation displacement, even severe comminuted radial head fractures ean be treated conservatively. By short-time immobilization and reasonabl
出处
《中华骨科杂志》
CAS
CSCD
北大核心
2018年第1期16-22,共7页
Chinese Journal of Orthopaedics
基金
2015年度北京市医院管理局青年人才培养“青苗”计划（QML20150404）
2015年度北京市医院管理局人才培养“登峰”计划（DFL20150401）
关键词
肘关节
桡骨骨折
身体锻炼
治疗结果
Elbow joint
Radius fractures
Exereise movement techniques
Treatment outcome
