摘要
[目的]比较人工桡骨头置换术与微型钢板结合Herbert螺钉内固定治疗Mason Ⅲ型桡骨头骨折的早期临床疗效。[方法]回顾分析2012年06月~2018年10月本院收治的49例Mason Ⅲ型桡骨头骨折患者,按手术方式不同,25例采用人工桡骨头置换术治疗(假体置换组),24例采用微型钢板结合Herbert螺钉内固定治疗(内固定组)。[结果]两组患者均顺利手术,无桡神经损伤,切口均一期愈合,无感染。假体置换组手术时间、术中出血量显著少于内固定组(P<0.05)。49例随访12~24个月,平均(15.28±3.04)个月。随术后时间推移,两组患者Morrey评分均显著增加(P<0.05)。术后1、6、12个月假体置换组的Morrey评分均显著高于内固定组(P<0.05)。假体置换组仅2例出现异位骨化;而内固定组中1例出现异位骨化、1例钢板断裂、2例骨折延迟愈合、1例发生骨折不愈合伴桡骨头畸形。假体置换组晚期并发症发生率显著低于内固定组(8.00%vs 20.83%, P<0.05)。[结论]与开放复位内固定术相比,人工桡骨头置换术治疗Mason Ⅲ型桡骨头骨折具有手术时间短、术中出血量少、肘关节功能恢复好、并发症发生率低等优点。
[Objective] To compare the early clinical outcomes of artificial radius head replacement versus internal fixation with miniplate and Herbert screw for treatment of Mason type Ⅲ radius head fracture.[Methods] A retrospective study was done on 49 patients who underwent surgical treatment for Mason type Ⅲ radial head fracture in our hospital from June 2012 to October 2018. In term of surgical procedures performed, 25 patients received artificial radius head replacement(the replacement group), while the remaining 24 patients underwent open reduction and internal fixation with miniplate and Herbert screws(the ORIF group).[Results] All the patients received successful operations without serious intraoperative complications, such as radial nerve injuries. The incisions got primary healing in all patients without infection. The replacement group consumed significantly shorter operation time, associated with significantly less intraoperative blood loss than the ORIF group(P<0.05). The follow up period lasted for 12~24 months with an average of(15.28±3.04) months. The Morrey score significantly increased in both groups as time went(P<0.05), however, the replacement group proved significantly superior to the ORIF group in Morrey score at 1, 6 and 12 months postoperatively(P<0.05). Regarding the late complication, only 2 cases of heterotopic ossification happened in the replacement group, whereas 1 case of heterotopic ossification, 1 case of plate breaking, 2 cases of delayed union of fracture and 1 case of nonunion of fracture accompanied with radial head deformity occurred in the ORIF group. The incidence of late complications proved significantly lower in the replacement group than the ORIF group(8.00% vs 20.83%, P<0.05).[Conclusion] The artificial radius head takes advantages of shortening operation time, reducing intraoperative bleeding, improving recovery of elbow joint function, and decreasing incidence of complications over the open reduction and internal fixation for Mason type Ⅲ radial head fractures.
作者
胡喜春
黄长明
范华强
张少战
付仰攀
董辉详
张运宽
HU Xi-chun;HUANG Chang-ming;FAN Hua-qiang;ZHANG Shao-zhan;FU Yang-pan;DONG Huixiang;ZHANG Yun-kuan(The Second Department of Orthopedics,Chenggong Hospital,73 Group Army Hospital,Xiamen University,Xiamen 361003,China)
出处
《中国矫形外科杂志》
CAS
CSCD
北大核心
2019年第20期1862-1866,共5页
Orthopedic Journal of China
