三种不同内固定方案治疗成人MasonⅡ型桡骨小头骨折的效果
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摘要
目的探讨微型钢板、Herbert螺钉及可吸收棒内固定术治疗MasonⅡ型桡骨小头骨折的临床效果及经济学价值。方法 2013年5月～2016年5月在荆州市中心医院接受治疗的MasonⅡ型桡骨小头骨折患者90例作为研究对象并分为A、B、C组,A组30例采取微型接骨板内固定术,B组28例采用Herbert螺钉内固定术,C组32例采用可吸收棒内固定术进行治疗。比较三组患者手术时间、术中出血量、术后骨折愈合时间、治疗费用、肘关节疼痛程度、肘关节功能优良率、活动力度及并发症发生情况,并对患者满意度进行调查。结果 B组和C组患者手术时间、术中出血量及术后2周疼痛评分均明显低于A组(P <0.05),C组住院费用明显低于A组和B组(P <0.05);术后6、12个月B组和C组肘关节活动度优于A组(P <0.05);三组患者满意度及术后并发症发生率比较,差异无统计学意义(P> 0.05)。结论 Herbert螺钉及可吸收骨内固定术治疗MasonⅡ型桡骨小头骨折的整体效果优于微型接骨板,但可吸收骨内固定术的治疗费用相对低于Herbert螺钉内固定术,建议优先选择。
Objective To evaluate the clinical efficacy and economics value of mini plate, Herbert screw and absorbable rod internal fixation in the treatment of Mason typeⅡ radial head fracture. Methods Form May 2013 to May2016 in Jingzhou City Center Hospital 90 cases of MasonⅡ type patients with fracture of radial capitulum were selected as the research object and divided into A, B, and C groups. Thirty patients in group A were treated with mini plate internal fixation, 28 patients in group B were treated with Herbert screw internal fixation, and 32 patients in group C were treated with absorbable rod internal fixation. The operation time, intraoperative blood loss, postoperative fracture healing time, the cost of treatment, the degree of elbow pain, elbow joint function excellent and good rate, activities intensity and the occurrence of complications were compared, and patients′ satisfaction were investigated in the three groups. Results The operative time, intraoperative blood loss and 2 weeks postoperative pain score of patients in group B and group C were significantly lower than those in group A(P < 0.05), and hospitalization cost of group C was significantly lower than that of group A and group B(P < 0.05). Elbow range of motion of group B and group C were better than that of group A 6 and 12 months after surgery(P < 0.05). There was no statistically significant difference in patient satisfaction and postoperative complication rate between the three groups(P > 0.05). Conclusion Herbert screw type and absorbable bone fixation treatment Mason Ⅱ the overall efficacy of radial capitulum fractures is better than that of the micro bone plate, but absorbable bone fixation treatment costs relatively lower than Herbert screw fixation,preferred choice.
Objective To evaluate the clinical efficacy and economics value of mini plate, Herbert screw and absorbable rod internal fixation in the treatment of Mason typeⅡ radial head fracture. Methods Form May 2013 to May2016 in Jingzhou City Center Hospital 90 cases of MasonⅡ type patients with fracture of radial capitulum were selected as the research object and divided into A, B, and C groups. Thirty patients in group A were treated with mini plate internal fixation, 28 patients in group B were treated with Herbert screw internal fixation, and 32 patients in group C were treated with absorbable rod internal fixation. The operation time, intraoperative blood loss, postoperative fracture healing time, the cost of treatment, the degree of elbow pain, elbow joint function excellent and good rate, activities intensity and the occurrence of complications were compared, and patients′ satisfaction were investigated in the three groups. Results The operative time, intraoperative blood loss and 2 weeks postoperative pain score of patients in group B and group C were significantly lower than those in group A(P < 0.05), and hospitalization cost of group C was significantly lower than that of group A and group B(P < 0.05). Elbow range of motion of group B and group C were better than that of group A 6 and 12 months after surgery(P < 0.05). There was no statistically significant difference in patient satisfaction and postoperative complication rate between the three groups(P > 0.05). Conclusion Herbert screw type and absorbable bone fixation treatment Mason Ⅱ the overall efficacy of radial capitulum fractures is better than that of the micro bone plate, but absorbable bone fixation treatment costs relatively lower than Herbert screw fixation,preferred choice.
引文
[1]何藻鹏,刘金伟,李卫,等.微型钢板螺钉内固定治疗MasonⅡ、Ⅲ型桡骨小头骨折的疗效[J].中国医学创新,2017,14(12):121-124.
[2]吴银生,许兵,王萧枫,等.手法闭合复位与切开复位内固定治疗青少年桡骨小头骨折临床对比研究[J].浙江中西医结合杂志,2017,27(3):223-225.
[3]王刚,于雁铭.可吸收棒治疗MasonⅡ、Ⅲ型桡骨小头骨折临床疗效分析[J].世界最新医学信息文摘,2016,12(35):27-30.
[4]Ca JP,Dai GD.Herbert screw fixation for the treatment of capitulum radius fracture:a report of 15 cases[J].Zhongguo Gu Shang,2011,24(10):876-878.
[5]陶天遵.新编实用骨科学[M].北京:军事医学科学出版社,2008,1999:357-360.
[6]Mason ML.Some observations on fractures of the head of the radius with a review of one hundred cases[J].Br JSurg,1954,42:123-132.
[7]白晨平.两种内固定方法治疗桡骨小头骨折的比较[J].中华手外科杂志,2016,32(4):253-254.
[8]吴加东,吕成堂,郭宗信,等.桡骨头骨折伴肘关节周围骨性不稳定的治疗[J].中华创伤骨科杂志,2016,18(1):83-85.
[9]张弛,仲飙,罗从风,等.外侧入路联合前内侧入路治疗肘关节“恐怖三联征”的手术疗效[J].中华骨科杂志,2015,35(4):320-327.
[10]Hagelberg M,Thune A,Krupic F,et al.Functional outcome after MasonⅡ-Ⅲradial head and neck fractures:study protocol for a systematic review in accordance with the PRISMA statement[J].Bmj Open,2017,7(1):e013022.
[11]周伟,刘平,袁冰,等.内固定治疗MasonⅡ、Ⅲ型桡骨小头骨折的疗效观察[J].生物骨科材料与临床研究,2016,13(5):72-74.
[12]王仲锋,王晓,李国军,等.骨折三维形态分型在MasonⅡ型桡骨头骨折Herbert螺钉内固定术中的应用[J].中医正骨,2016,28(3):38-41.
[13]罗亚平,常小波,王勤业,等.切开复位微型钢板内固定治疗MasonⅡ型桡骨小头骨折[J].国际骨科学杂志,2014,35(3):199-200.
[14]Demiroglu M,Ozturk K,Baydar M,et al.Results of screw fixation in Mason type II radial head fractures[J].Springerplus,2016,5(1):1-7.
[15]李利平,曲成明,刘圆圆,等.Herbert螺钉内固定治疗第5跖骨基底骨折[J].实用骨科杂志,2017,23(4):374-376.(上接第65页)
[16]宣科,李丕杰,谢祖宏,等.Herbert螺钉内固定治疗桡骨小头骨折疗效观察[J].现代实用医学,2016,28(11):1484-1485.
[17]庄云强,张军,周龙,等.微型钢板治疗桡骨小头骨折安全区的确定[J].创伤外科杂志,2016,18(11):656-658.
[18]陈长青,周影,王耀生,等.可吸收棒与微型钢板治疗桡骨小头骨折的对比研究[J].中国中医骨伤科杂志,2016,24(11):30-34.
[19]陈鹏,傅德皓.Herbert螺钉与钢板治疗MasonⅡ型桡骨小头骨折临床分析[J].实用骨科杂志,2015,21(2):160-162.
[20]王思成,张友忠,杨国庆,等.可吸收棒与Herbert螺钉修复桡骨小头骨折:治疗效应及经济学的比较[J]中国组织工程研究,2014,18(26):4153-4157.
[21]Su Y,Xie Y,Qin J,et al.Internal Fixation With Absorbable Rods for the Treatment of Displaced Radial Neck Fractures in Children[J].J Pedatr Orthop,2016,36(8):797-802.
[22]向成浩,陈文革,蒋从斌,等.可吸收棒治疗MasonⅡ、Ⅲ型桡骨小头骨折临床疗效分析[J].生物骨科材料与临床研究,2015,12(5):27-30.
[2]吴银生,许兵,王萧枫,等.手法闭合复位与切开复位内固定治疗青少年桡骨小头骨折临床对比研究[J].浙江中西医结合杂志,2017,27(3):223-225.
[3]王刚,于雁铭.可吸收棒治疗MasonⅡ、Ⅲ型桡骨小头骨折临床疗效分析[J].世界最新医学信息文摘,2016,12(35):27-30.
[4]Ca JP,Dai GD.Herbert screw fixation for the treatment of capitulum radius fracture:a report of 15 cases[J].Zhongguo Gu Shang,2011,24(10):876-878.
[5]陶天遵.新编实用骨科学[M].北京:军事医学科学出版社,2008,1999:357-360.
[6]Mason ML.Some observations on fractures of the head of the radius with a review of one hundred cases[J].Br JSurg,1954,42:123-132.
[7]白晨平.两种内固定方法治疗桡骨小头骨折的比较[J].中华手外科杂志,2016,32(4):253-254.
[8]吴加东,吕成堂,郭宗信,等.桡骨头骨折伴肘关节周围骨性不稳定的治疗[J].中华创伤骨科杂志,2016,18(1):83-85.
[9]张弛,仲飙,罗从风,等.外侧入路联合前内侧入路治疗肘关节“恐怖三联征”的手术疗效[J].中华骨科杂志,2015,35(4):320-327.
[10]Hagelberg M,Thune A,Krupic F,et al.Functional outcome after MasonⅡ-Ⅲradial head and neck fractures:study protocol for a systematic review in accordance with the PRISMA statement[J].Bmj Open,2017,7(1):e013022.
[11]周伟,刘平,袁冰,等.内固定治疗MasonⅡ、Ⅲ型桡骨小头骨折的疗效观察[J].生物骨科材料与临床研究,2016,13(5):72-74.
[12]王仲锋,王晓,李国军,等.骨折三维形态分型在MasonⅡ型桡骨头骨折Herbert螺钉内固定术中的应用[J].中医正骨,2016,28(3):38-41.
[13]罗亚平,常小波,王勤业,等.切开复位微型钢板内固定治疗MasonⅡ型桡骨小头骨折[J].国际骨科学杂志,2014,35(3):199-200.
[14]Demiroglu M,Ozturk K,Baydar M,et al.Results of screw fixation in Mason type II radial head fractures[J].Springerplus,2016,5(1):1-7.
[15]李利平,曲成明,刘圆圆,等.Herbert螺钉内固定治疗第5跖骨基底骨折[J].实用骨科杂志,2017,23(4):374-376.(上接第65页)
[16]宣科,李丕杰,谢祖宏,等.Herbert螺钉内固定治疗桡骨小头骨折疗效观察[J].现代实用医学,2016,28(11):1484-1485.
[17]庄云强,张军,周龙,等.微型钢板治疗桡骨小头骨折安全区的确定[J].创伤外科杂志,2016,18(11):656-658.
[18]陈长青,周影,王耀生,等.可吸收棒与微型钢板治疗桡骨小头骨折的对比研究[J].中国中医骨伤科杂志,2016,24(11):30-34.
[19]陈鹏,傅德皓.Herbert螺钉与钢板治疗MasonⅡ型桡骨小头骨折临床分析[J].实用骨科杂志,2015,21(2):160-162.
[20]王思成,张友忠,杨国庆,等.可吸收棒与Herbert螺钉修复桡骨小头骨折:治疗效应及经济学的比较[J]中国组织工程研究,2014,18(26):4153-4157.
[21]Su Y,Xie Y,Qin J,et al.Internal Fixation With Absorbable Rods for the Treatment of Displaced Radial Neck Fractures in Children[J].J Pedatr Orthop,2016,36(8):797-802.
[22]向成浩,陈文革,蒋从斌,等.可吸收棒治疗MasonⅡ、Ⅲ型桡骨小头骨折临床疗效分析[J].生物骨科材料与临床研究,2015,12(5):27-30.