切开复位内固定治疗移位的桡骨头骨折

[目的]探讨切开复位内固定治疗成人移位桡骨头骨折的手术技术。[方法]本组移位桡骨头骨折26例,MasonⅡ型16例,Ⅲ型6例,Ⅳ型4例。22例用肘后外侧Kocher切口,另外4例用肘后正中切口以便同时处理合并的尺骨近端骨折。复位后用微型钢板螺钉固定,并使内固定物不妨碍关节活动。[结果]随访平均32个月,无骨间后神经损伤及感染发生,26例骨折均顺利愈合。按照Broberg和Morrey肘部评分标准,优17例,良9例。[结论]切开复位内固定治疗移位桡骨头骨折可取得满意疗效,术中应注意以下方面：（1）保护、修复尺骨外侧副韧带;（2）防止损伤骨间后神经;（3）努力达到解剖复位;（4）固定既要坚强可靠,又要不阻碍关节的运动。

Open reduction and internal fixation of displaced radial head fractures

[Objective]To explore the operative techniques of open reduction and internal fixation of displaced radial head fractures in adults. [Methods]Twenty-six cases of radial head fractures had been treated with open reduction and internal fixation. According to Mason classification, 16 fractures were type II, 6 were type III and 4 were type IV. Operative exposures of radial head were performed through the Kocher approach in 22 cases, and through a midline posterior skin incision in 4 cases in order to repair concomitant fracture of proximal ulna. After being reduced, fractures of radial head were fixed with mini-fragment plate and screw which were placed in "safe zone" not to impinge on the proximal radioulnar joint with forearm rotation.[Results]At a mean follow-up of 32 months, all fractures had united. There was no patient who suffered from wound infection or injury to posterior interosseous nerve. According to the Broberg and Morrey functional elbow index, the outcome were excellent in 17 patients, good in 9.[Conclusion]Open reduction and internal fixation of displaced radial head fractures may get satisfying outcomes, with successful performing of the requirements below: (1) sustaining lateral ulnar collateral ligament; (2) avoiding injury to posterior inerosseous nerve; (3) getting anatomic reduction; (4) stably fixing fractures without impinging on joint.