肘前、外侧两种手术入路治疗桡骨头骨折的比较

目的探讨显露桡骨头骨折的有效手术入路。方法采用肘前侧手术入路显露桡骨头并结合微型空心螺钉固定治疗桡骨头骨折12例，其中2例MasonⅢ型骨折的骨折块于前臂完全旋后时位于桡骨头的前侧。采用传统的肘外侧手术入路10例，显露桡骨头骨折并用微型空心螺钉埋头固定。结果前侧手术入路显露骨折时间平均为20．7分，外侧入路显露骨折时间平均为11．6分。按照Broberg和Morrey肘关节评分标准评定手术疗效：前侧入路组优良率为92％，外侧入路组优良率为90％，两组间无明显差异。结论肘前侧入路可有效显露并固定桡骨头骨折，降低桡神经深支损伤的可能性，尤其适用于治疗前臂完全旋后时桡骨头前侧骨折这一特殊类型骨折。两种入路可视具体情况加以选用。

Comparison of anterior approach with lateral approach for internal fixation of radial head fractures

Objective To discuss effective operative approach for internal fixation of radial head fractures. Methods 12 cases of radial head fractures were operated upon through anterior approach for internal fixation of radial head fractures with mini-cannulated screws, and fractures of 2 cases of Mason Ⅲ type were in the anterior part of radial head with forearm in total supination. 10 cases of radial head fractures were operated upon through lateral approach for internal fixation of radial head fractures with mini-cannulated screws. Results The average exposure time for radial head fractures through anterior approach was 20.7 minutes, and was 11.6 minutes through lateral approach. According to Broberg-Morrey＇s elbow evaluation criterion, the excellent and good rate of anterior approach was 92%, and was 90% of lateral approach. There was no statistical significance between two approaches. Conclusion Anterior approach is an effective method for exposure and internal fixation of radial head fractures, decreasing the injury to deep branch of radial nerve, and is especially suitable for anterior fractures of radial head with forearm in supination. Which approach should be used depends on each detailed case.