手术治疗桡骨头骨折的疗效分析
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摘要
[目的]探讨不同类型桡骨头骨折手术治疗方法及其疗效。[方法]回顾分析2006年1月～2015年6月本科收治的57例桡骨头骨折的患者。根据Mason分型,其中Ⅱ型19例、Ⅲ型33例、Ⅳ型5例。根据骨折类型,Ⅱ型19例中,14例采用切开复位内固定,4例采用克氏针闭合撬拨复位,1例采用切开撬拨复位。Ⅲ型33例中,15例采用桡骨头置换,12例采用切开复位内固定,6例采用桡骨头切除。Ⅳ型5例中,4例采用切开复位内固定,其中1例同时使用外固定架,1例采用桡骨头置换。采用肘关节活动度、Mayo肘关节功能评分评价临床效果。[结果] 49例患者获得随访,随访时间11～48个月,平均(28.53±6.54)个月。末次随访时根据Mayo肘关节功能评分标准评定疗效:优40例,良7例,中2例;优良率为95.92%。所有病例内固定及假体均未见松动,无1例发生感染和神经损伤。末次随访时X线片显示4例(Ⅲ型3例,Ⅳ型1例)发生异位骨化。Mason Ⅱ、Ⅲ、Ⅳ型骨折患者术后患侧肘关节活动范围小于健侧,差异有统计学意义(P<0.05)。[结论] Mason Ⅱ型骨折采用切开复位内固定可取得满意效果,Ⅲ、Ⅳ型首选切开复位内固定,若无法重建桡骨头,可选择人工桡骨头置换,对于桡骨头切除应当慎重选择。
[Objective] To evaluate the operative methods and their therapeutic outcomes for different types of radial head fractures. [Methods] A retrospective study was conducted on 57 patients who underwent surgical treatment for radial head fractures from January 2006 to June 2015. In term of Mason classification, 19 patients were of Mason type Ⅱ fractures, 33 cases of Mason type Ⅲ fractures, and 5 cases of Mason type Ⅳ fractures. Of the 19 patients with type Ⅱ fracture, 14 had open reduction and internal fixation(ORIF), 1 underwent close poking reduction with Kirschner wire, and 1 received open poking reduction.By contrast, among 33 patients with type Ⅲ fracture, 15 had radial head replacement, 12 underwent ORIF and 6 received radial head resection. For the 5 patients with type Ⅳ fracture, 4 received ORIF including 1 combined with external fixator simultaneously, and 1 had radial head replacement. The elbow range of motion(ROM) and Mayo elbow score were used for evaluation of the clinical consequences. [Results] Of them, 49 patients were followed up for 11 to 48 months with an average of 28.5 months.Based on Mayo elbow score, the clinical outcomes were graded as excellent in 40, good in 7 and fair in 2 patients, associated with excellent and good rate of 95.9%. No complications, such as nerve injuries, infection, prosthetic loosening, were noted in any of them, despite of the fact that heterotopic ossification was revealed in radiographs in 4 patients. However, the elbow ROMs of the injured sides were statistically inferior to the unaffected sides in the Mason type Ⅱ, Ⅲ and Ⅳ fractures(P<0.05). [Conclusion] ORIF does achieve satisfactory results for Mason type Ⅱ fractures. In addition, ORIF should also be considered as first choice for Mason type Ⅲ and Ⅳ fractures. If ORIF failed, radial head replacement should be performed, however, radial head resection should be cautiously selected.
[Objective] To evaluate the operative methods and their therapeutic outcomes for different types of radial head fractures. [Methods] A retrospective study was conducted on 57 patients who underwent surgical treatment for radial head fractures from January 2006 to June 2015. In term of Mason classification, 19 patients were of Mason type Ⅱ fractures, 33 cases of Mason type Ⅲ fractures, and 5 cases of Mason type Ⅳ fractures. Of the 19 patients with type Ⅱ fracture, 14 had open reduction and internal fixation(ORIF), 1 underwent close poking reduction with Kirschner wire, and 1 received open poking reduction.By contrast, among 33 patients with type Ⅲ fracture, 15 had radial head replacement, 12 underwent ORIF and 6 received radial head resection. For the 5 patients with type Ⅳ fracture, 4 received ORIF including 1 combined with external fixator simultaneously, and 1 had radial head replacement. The elbow range of motion(ROM) and Mayo elbow score were used for evaluation of the clinical consequences. [Results] Of them, 49 patients were followed up for 11 to 48 months with an average of 28.5 months.Based on Mayo elbow score, the clinical outcomes were graded as excellent in 40, good in 7 and fair in 2 patients, associated with excellent and good rate of 95.9%. No complications, such as nerve injuries, infection, prosthetic loosening, were noted in any of them, despite of the fact that heterotopic ossification was revealed in radiographs in 4 patients. However, the elbow ROMs of the injured sides were statistically inferior to the unaffected sides in the Mason type Ⅱ, Ⅲ and Ⅳ fractures(P<0.05). [Conclusion] ORIF does achieve satisfactory results for Mason type Ⅱ fractures. In addition, ORIF should also be considered as first choice for Mason type Ⅲ and Ⅳ fractures. If ORIF failed, radial head replacement should be performed, however, radial head resection should be cautiously selected.
引文
[1] Jackson JD, Steinmann SP. Radial head fractures[J]. Hand Clin,2007, 23(2):185-193.
[2] Duckworth AD, Wickramasinghe NR, Clement ND, et al. Longterm outcomes of isolated stable radial head fractures[J]. J Bone Joint Surg Am, 2014, 96(20):1716-1723.
[3] Morrey BF, Adams RA. Semiconstrained arthroplasty for the treat-ment of rheumatoid arthritis of the elbow[J]. J Bone Joint Surg Am, 1992, 74(4):479-490.
[4] Iftimie PP, Calmet GJ, De LG FI, et al. Resection arthroplasty for radial head fractures:Long-term follow-up[J]. J Shoulder Elbow Surg, 2011, 20(1):45-50.
[5] Karlsson MK, P?r H, Anders N, et al. Long-term outcome of displaced radial neck fractures in adulthood[J]. Acta Orthop, 2009,80(3):368-370.
[6] Antu?a SA, Sánchez-Márquez JM, Barco R. Long-term results of radial head resection following isolated radial head fractures in patients younger than forty years old[J]. J Bone Joint Surg Am, 2010,92(3):558-566.
[7] Herbertsson P, Hasserius R, Josefsson PO, et al. Mason type IV fractures of the elbow:a 14-to 46-year follow-up study[J]. J Bone Joint Surg Br, 2009, 91(1):1499-1504.
[8] Fuchs S, Chylarecki C. Do functional deficits result from radial head resection[J]. J Shoulder Elbow Surg, 1999, 8(3):247-251.
[9] Mikíc ZD, Vukadinovíc SM. Late results in fractures of the radial head treated by excision[J]. Clin Orthop, 1983, 181(181):220-228.
[10] King GJ, Patterson SD. Metallic radial head arthroplasty[J]. Tech Hand Upper Extr Surg, 2001, 5(4):196-203.
[11] Ring D. Displaced, unstable fractures of the radial head:fixation vs. replacement-what is the evidence[J]. Injury, 2008, 39(12):1329-1337.
[12] Ring D. Open reduction and internal fixation of fractures of the radial head[J]. J Bone Joint Surg Am, 2002, 84(10):1811-1815.
[13] Giannicola G, Manauzzi E, Sacchetti FM, et al. Anatomical variations of the proximal radius and their effects on osteosynthesis[J].J Hand Surg, 2012, 37(5):1015.
[14] Kuhn S, Burkhart KJ, Schneider J, et al. The anatomy of the proximal radius:implications on fracture implant design[J]. J Shoulder Elbow Surg, 2012, 21(9):1247-1254.
[15] Zunkiewicz MR, Clemente JS, Miller MC, et al. Radial head replacement with a bipolar system:a minimum 2-year follow-up.[J]. J Shoulder Elbow Surg, 2012, 21(1):98-104.
[16] Grewal R, Macdermid JC, Faber KJ, et al. Comminuted radial head fractures treated with a modular metallic radial head arthroplasty.Study of outcomes[J]. J Bone Joint Surg, 2006, 88(10):2192-2200.
[17] Zwingmann J, Welzel M, Dovi-Akue D, et al. Clinical results after different operative treatment methods of radial head and neck fractures:a systematic review and meta-analysis of clinical outcome.[J]. Injury, 2013, 44(11):1540–1550.
[2] Duckworth AD, Wickramasinghe NR, Clement ND, et al. Longterm outcomes of isolated stable radial head fractures[J]. J Bone Joint Surg Am, 2014, 96(20):1716-1723.
[3] Morrey BF, Adams RA. Semiconstrained arthroplasty for the treat-ment of rheumatoid arthritis of the elbow[J]. J Bone Joint Surg Am, 1992, 74(4):479-490.
[4] Iftimie PP, Calmet GJ, De LG FI, et al. Resection arthroplasty for radial head fractures:Long-term follow-up[J]. J Shoulder Elbow Surg, 2011, 20(1):45-50.
[5] Karlsson MK, P?r H, Anders N, et al. Long-term outcome of displaced radial neck fractures in adulthood[J]. Acta Orthop, 2009,80(3):368-370.
[6] Antu?a SA, Sánchez-Márquez JM, Barco R. Long-term results of radial head resection following isolated radial head fractures in patients younger than forty years old[J]. J Bone Joint Surg Am, 2010,92(3):558-566.
[7] Herbertsson P, Hasserius R, Josefsson PO, et al. Mason type IV fractures of the elbow:a 14-to 46-year follow-up study[J]. J Bone Joint Surg Br, 2009, 91(1):1499-1504.
[8] Fuchs S, Chylarecki C. Do functional deficits result from radial head resection[J]. J Shoulder Elbow Surg, 1999, 8(3):247-251.
[9] Mikíc ZD, Vukadinovíc SM. Late results in fractures of the radial head treated by excision[J]. Clin Orthop, 1983, 181(181):220-228.
[10] King GJ, Patterson SD. Metallic radial head arthroplasty[J]. Tech Hand Upper Extr Surg, 2001, 5(4):196-203.
[11] Ring D. Displaced, unstable fractures of the radial head:fixation vs. replacement-what is the evidence[J]. Injury, 2008, 39(12):1329-1337.
[12] Ring D. Open reduction and internal fixation of fractures of the radial head[J]. J Bone Joint Surg Am, 2002, 84(10):1811-1815.
[13] Giannicola G, Manauzzi E, Sacchetti FM, et al. Anatomical variations of the proximal radius and their effects on osteosynthesis[J].J Hand Surg, 2012, 37(5):1015.
[14] Kuhn S, Burkhart KJ, Schneider J, et al. The anatomy of the proximal radius:implications on fracture implant design[J]. J Shoulder Elbow Surg, 2012, 21(9):1247-1254.
[15] Zunkiewicz MR, Clemente JS, Miller MC, et al. Radial head replacement with a bipolar system:a minimum 2-year follow-up.[J]. J Shoulder Elbow Surg, 2012, 21(1):98-104.
[16] Grewal R, Macdermid JC, Faber KJ, et al. Comminuted radial head fractures treated with a modular metallic radial head arthroplasty.Study of outcomes[J]. J Bone Joint Surg, 2006, 88(10):2192-2200.
[17] Zwingmann J, Welzel M, Dovi-Akue D, et al. Clinical results after different operative treatment methods of radial head and neck fractures:a systematic review and meta-analysis of clinical outcome.[J]. Injury, 2013, 44(11):1540–1550.