摘要
目的:比较桡骨头置换术与T形钢板联合Herbert螺钉内固定术治疗Mason-JohnstonⅢ型桡骨头骨折的临床疗效及安全性。方法:将46例Mason-JohnstonⅢ型桡骨头骨折患者随机分为2组,采用桡骨头置换术治疗23例,采用T形钢板联合Herbert螺钉内固定术治疗23例。男21例,女25例。年龄18~63岁,中位数46岁。均为闭合性骨折,左侧16例、右侧30例。受伤至手术时间3~7 d,中位数4 d。比较2组患者的手术时间、术中出血量及并发症发生率,并于末次随访时比较2组患者的临床疗效。结果:所有患者均获随访,随访时间11~13个月,中位数12个月。桡骨头置换组的手术时间短于钢板联合螺钉组,术中出血量少于钢板联合螺钉组[(49.48±6.17)min,(58.57±12.79)min,t=-3.069,P=0.004;(50.49±9.63)m L,(64.26±12.94)m L,t=-4.096,P=0.000]。桡骨头置换组1例出现肘关节僵硬,采用肘关节松解术治疗后关节功能恢复。钢板联合螺钉组3例出现肘关节僵硬,采用肘关节松解术治疗后关节功能恢复;1例出现内固定失效,1例出现骨折不愈合,采用桡骨头置换术治疗后效果满意。2组患者的并发症发生率比较,差异无统计学意义(P=0.189)。末次随访时,按照Mayo肘关节功能评分标准评定疗效,桡骨头置换组的疼痛评分及运动评分高于钢板联合螺钉组[(42.39±5.81)分,(37.17±9.98)分,t=2.166,P=0.037;(19.78±1.04)分,(18.48±2.79)分,t=2.098,P=0.045];两组的稳定性评分、日常生活功能评分及总分比较,组间差异无统计学意义[(9.57±1.44)分,(8.69±2.24)分,t=1.563,P=0.126;(24.13±1.94)分,(21.96±4.94)分,t=1.965,P=0.059;(95.87±7.33)分,(88.91±16.85)分,t=1.815,P=0.079]。桡骨头置换组优14例、良8例、差1例,钢板联合螺钉组优8例、良8例、可4例、差3例,桡骨头置换组的临床综合疗效优于钢板联合螺钉组(Z=-2.171,P=0.030)。结论:桡骨头置换术与T形钢板联合Herbert螺钉内固定术治疗Mason-JohnstonⅢ型桡骨头骨折的安全性相当,但前者具有手术时间短、术中出血量少、疼痛程度轻、运动功能恢复良好、临床综合疗效好的优点,值得临床推广应用。
Objective： To compare the clinical curative effects and safety of radial head replacement versus internal fixation with T-shape steel plate and Herbert screws for treatment of Mason-Johnston typeⅢradial head fractures. Methods： Forty-six patients with Mason-Johnston typeⅢradial head fractures were randomly divided into 2 groups,23 cases in each group,and were treated with radial head replacement（ group A） and internal fixation with T-shape steel plate and Herbert screws（ group B） respectively. The patients consisted of21 males and 25 females and ranged in age from 18 to 63 years（ Median = 46 yrs） and ranged in disease course from 3 to 7 days（ Median =4 days）. The fractures located in left side for 16 patients and right side for 30 patients,and belonged to closed fractures. The operative time,intraoperative blood loss and complication incidences were recorded and compared between the 2 groups,and the clinical effects were compared between the 2 groups at last follow-up. Results： All patients in the 2 groups were followed up for 11-13 months with a median of 12 months. The operative time was shorter and the intraoperative blood loss was less in group A compared to group B（ 49. 48 ＋/-6. 17 vs58. 57 ＋/-12. 79 min,t =-3. 069,P = 0. 004; 50. 49 ＋/-9. 63 vs 64. 26 ＋/-12. 94 m L,t =-4. 096,P = 0. 000）. Elbow joint stiffness was found in group A（ 1 case） and group B（ 3 cases）,and the elbow joint function recovered after elbow arthrolysis. Failed internal fixation（ 1） and fracture nonunion（ 1） were found in group B and the patients got a good result after radial head replacements. There was no statistical difference in complication incidences between the 2 groups（ P = 0. 189）. The clinical effects were evaluated according to Mayo elbow performance scores at last follow-up,and the results showed that pain scores and motor scores were higher in group A compared to group B（ 42. 39 ＋/-5. 81 vs 37. 17 ＋/-9. 98 points,t = 2. 166,P = 0. 037; 19. 78 ＋/-1. 04 vs 18. 48 ＋/-2. 79 points,t = 2. 098,P = 0. 045） and there was no statistical difference in stability scores,activity of daily living（ ADL） scores and total scores between the 2 groups（ 9. 57 ＋/-1. 44 vs 8. 69 ＋/-2. 24 points,t = 1. 563,P = 0. 126; 24. 13 ＋/-1. 94 vs 21. 96 ＋/-4. 94 points,t = 1. 965,P = 0. 059; 95. 87 ＋/-7. 33 vs88. 91 ＋/-16. 85 points,t = 1. 815,P = 0. 079）. Fourteen patients obtained an excellent result,8 good and 1 poor in group A; while 8 patients obtained an excellent result,8 good,4 fair and 3 poor in group B. The group A surpassed the group B in the total clinical curative effects（ Z =-2. 171,P = 0. 030）. Conclusion： Radial head replacement and internal fixation with T-shape steel plate and Herbert screws are similar to each other in safety in treatment of Mason-Johnston typeⅢradial head fractures,however,the former has such advantages as shorter operative time,less intraoperative blood loss,less pain,better motor function and better clinical comprehensive effect,so it is worthy of popularizing in clinic.
作者
钟良钰
杜兰翔
王志相
厉江群
刘盛飞
吴秋敏
ZHONG Liangyu;DU Lanxiang;WANG Zhixiang;LI Jiangqun;LIU Shengfei;WU Qiumin(Ganzhou Hospital of Traditional Chinese Medicine,Ganzhou 341000,Jiangxi,China)
出处
《中医正骨》
2018年第8期21-25,共5页
The Journal of Traditional Chinese Orthopedics and Traumatology
关键词
桡骨骨折
肘关节
关节成形术
置换
骨折固定术
内
临床试验
radius fractures
elbow joint
arthroplasty,replacement
fracture fixation
internal
clinical trial
