关节镜下与切开复位Herbert钉内固定治疗桡骨小头骨折短期疗效比较

目的比较关节镜下与切开复位Herbert钉内固定治疗桡骨小头骨折的短期临床疗效。方法采用回顾性病例对照研究分析2017年1月至2018年12月上海中冶医院收治的38例单侧桡骨小头骨折(MasonⅡ型)患者的临床资料,其中男22例,女16例;年龄20~65岁(37.4±12.6)岁]。20例采用关节镜下复位Herbert钉内固定治疗(A组),18例采用切开复位Herbert钉内固定治疗(B组)。比较两组手术时间、骨折愈合时间及术前、术后1,3,6,12个月视觉模拟评分(VAS)、肘关节屈伸范围、前臂旋转范围、Mayo肘关节功能评分(MEPS)及上肢功能评定表(DASH)评分。同时评估并发症情况,包括螺钉松动、断裂或骨折移位等情况。结果患者均获随访12~14个月(12.3±2.3)个月]。两组手术时间差异无统计学意义(P>0.05)。骨折愈合时间A组为(8.9±0.6)周,B组为(8.7±0.6)周(P>0.05)。术前两组VAS差异无统计学意义(P>0.05);术后1个月时A组VAS为(4.8±0.5)分,低于B组的(6.0±0.7)分(P<0.05);术后3,6,12个月时A组与B组VAS差异均无统计学意义(P>0.05)。术前两组关节屈伸范围差异无统计学意义(P>0.05);术后1,3个月时A组肘关节屈伸范围分别为(110.4±3.8)°、(137.1±4.04)°,显著大于B组的(90.6±4.7)°、(125.1±3.5)°(P<0.05);术后6,12个月时A组和B组肘关节屈伸范围差异均无统计学意义(P>0.05)。术前两组肘前臂旋转范围差异无统计学意义(P>0.05);术后1,3个月时A组前臂旋转范围分别为(107.1±2.8)°、(138.1±2.9)°,显著大于B组的(95.5±3.9)°、(121.5±3.0)°(P<0.05);术后6,12个月时A组和B组前臂旋转范围差异均无统计学意义(P>0.05)。术前两组MEPS差异无统计学意义(P>0.05);术后1个月时A组MEPS为(50.4±3.8)分,高于B组的(40.6±4.7)分(P<0.05);术后3,6,12个月时A组和B组MEPS差异均无统计学意义(P>0.05)。术前两组DASH评分差异无统计学意义(P>0.05);术后1个月时A组DASH评分为(57.1±2.8)分,高于B组的(42.5±3.9)分(P<0.05);术后3,6,12个月时A组和B组DASH评分差异均无统计学意义(P>0.05)。术后均未发生螺钉松动或断裂,两组各有1例患者出现骨折再移位(P>0.05)。结论对于MasonⅡ型桡骨头骨折,关节镜下Herbert钉内固定较切开复位Herbert钉内固定治疗具有疼痛轻、患肢早期功能恢复快等优势。

Comparison of short-term effects of arthroscopic and open reduction and internal fixation with Herbert screws in treatment of radial head fractures

Objective To compare the short-term clinical effect of arthroscopic and open reduction and intemal fixation with Herbert screws in treatment of Mason type Ⅱ radial head fractures.Methods A retrospetive case-control study was conducted to analyze the elinical data of 38 patients with umilateral radial head fractures(Mason type Ⅱ)adnmited to Shanghai Zhongye Hospial from January 2017 to December 2018。including 22 males and 16 females,aged from 20 to 65 years(37.4±12.6)years].Twenty patients were teated by arthnoscopie reduction and intenal fixation with Hebert screw(Group A),and eighteen by open reduction and internal fixation with Herbert screw(Goup B).The operation time and fracture hbealing time were recorded.The visual analogue scale(VAS).elbow lexion and exlension range,forearn rotation range and Mayo ebow function score were compared between the two groups before and at 1,3,6,and 12 months ater operation.The results of Mayo elbow perfornance score(MEPS)and upper limb function ssssent using the disabilites of the arm,shoulder,and hand(DASH)soore were compared between the lwo groups.Complications including screw breakage or fracture displacenent were also evaluated.Results All patients were fllowed up for 12-14 mnonhs(12.3±2.3)months].There was no significant dfference in operation time betwen the two groups(P>0.05).The fracture healing time was(8.9±0.6)weeks in Group A and(8.7±0.6)weeks in Group B(P>0.05).There was no signifcant dilrence in VAS between the two groups before operation(P>0.05).The VAS was(4.8±0.5)points at 1 month after opention in Group A,lower than(6.0±0.7)points in Group B(P<0.05).There was no significant dilrence in VAS between Group A and Group B at 3,6,and 12 muhs after openation(P>0.05).Thene was mo significant diference in elbow flexion and extension range between the two groups before operation(P>0.05).The elbow flexion and extension range in Group A was(110.413.8)°and(137.1±4.0)°at 1,3 months ater operation,which was signifcant greater than(90.6±4.7)°and(125.113.5)°in Group B(P<0.05).There was no signifcant dfference in elbow flexion and extension range between the two groups al 6 and 12 monhs after operation(P>005).There was no signifcant dfference in the range of foream rotation between the two groups before operation(P>0.05).The range of forearm rotation in Group A was(107.1±2.8)°and(138.1±2.9)°at 1,3 months afer operation,sigifianly greater than(95.5±3.9)°,(121.5±3.0)°in Group B(P<0.05).There was no significant diference in forearm rotation range between the two groups all 6 and 12 months after surgery(P>0.05).There was no significant diference in MEPS between the two groups before operation(P>0.05).The MEPS in Group A was(50.4±3.8)prints at 1 month ater operation,higher than(40.6±4.7)points in Group B(P<005).There was n signifcant dilrence in MEPS between the two groups 3,6,and 12 months after operation(P>0.05).There was no signifeant difrence in DASH score between the two groups before operation(P>0.05).The DASH score was(57.1±2.8)pints at 1 month afer surgery in Group A,higher than(42.5±3.9)points in Group B(P<0.05).The DASH sore was not signifeantly diferent between the lwo groupe at 3,6,and 12 mouths after operation(P>0.05).There was no surew losening or fracture afer operation,and one patient in each group had fracture displacement(P>0.05).Conclusion For Mason type Ⅱ nedial head fractures。arthroscopic Herbert screw fixation has the advantages of less trauna,les pain and faster functional recovery of the afced limb compared with open reduction and Herbert secrew fixation.