Modified cannulated screw fixation in the treatment of Pauwels type III femoral neck fractures: A biomechanical study

BackgroundAchieving satisfactory internal fixation for patients with Pauwels type III femoral neck fractures has become a critical problem. The purpose of this study was to compare a common standard internal reduction and fixation method for femoral neck fractures to the modified fixation methods.MethodsA computed tomography scan of the femur was performed to make a Three-dimensional (3D) model, and a fracture line was simulated in the femoral neck. 3Dfinite element analysis was carried out for different insertion methods of cannulated tension screws. Six healthy femur specimens were harvested from three formalin-fixed cadavers, and Pauwels type III femoral neck fracture was artificially created in bilateral femurs. The right side was treated with the inverted triangle construct method and the left side by the modified screw fixation method. After fixation, uniaxial compression and maximum load experiments on the bilateral femoral necks were carried out using the non-contact full-field dynamic strain measurement system (VIC-3D) on a pressure testing machine.FindingsBoth 3D finite element analysis and biomechanical study showed that the modified screw fixation method(group D) provided better anti-shearing and anti-rotation properties for Pauwels type III femoral neck fractures, and offered better interfragmentary compression. Therefore, this modified screw fixation method can offer patients a better option for treatment of Pauwels type III femoral neck fractures.InterpretationChanging the placement of the anterosuperior screw in the inverted triangle construct as perpendicular to the fracture line has the advantages in anti-shearing, anti-rotation and increasing interfragmentary compression.     

可吸收棒与Herbert螺钉修复桡骨小头骨折：治疗效应及经济学的比较

背景：MasonⅡ型以及骨折块较大的的Ⅲ型桡骨小头骨折多采用切开复位金属内固定物治疗,但金属内固定材料大多需二次手术取出,增加了患者的痛苦及经济负担,采用可吸收钉棒也可治疗桡骨小头骨折,且因其价格较低及无需二次手术取出的特点,具有独特的优势。目的：比较可吸收棒与Herbert螺钉内固定治疗Mason Ⅱ或Ⅲ型桡骨小头骨折的临床疗效。方法：将80例Mason Ⅱ和Ⅲ型桡骨小头骨折等分为实验组和对照组给予切开复位内固定治疗,实验组采用可吸收棒内固定,对照组采用Herbert螺钉内固定。结果与结论：其中79例患者获随访,平均随访34个月。实验组和对照组患者的平均手术时间、骨折愈合时间、Broberg和Morrey肘关节功能评分及并发症发生率比较差异无显著性意义（P 〉0.05）,但实验组患者住院费用低于对照组（P 〈0.05）。提示可吸收棒与Herbert螺钉内固定治疗Mason Ⅱ或Ⅲ型桡骨小头骨折的疗效近似,但可吸收棒内固定治疗桡骨小头骨折可以避免二次手术取出内固定物,因此在内固定材料选择上建议优先选用可吸收棒。     

聚-DL-乳酸可吸收螺钉应用于Pipkin骨折13例:中长期安全性随访

目的:评价聚-DL-乳酸可吸收螺钉在髋关节后脱位合并股骨头骨折(Pipkin骨折)中的应用疗效及安全性.方法:选择2002-03/2007-10苏州大学附属第一医院骨科和吴江市第三人民医院骨科入选的Pipkin骨折患者13例,男10例,女3例:平均年龄30.5岁.按Pipkin分型,Ⅰ型6例,Ⅱ型4例,Ⅳ型3例.切口采用后侧Kocher-Langenbeck入路.结果:平均随访47.9个月,骨折均得以愈合,1例出现股骨头坏死,1例存在髋关节持续疼痛,未见异位骨化发生.未发生材料断裂、松动等材料反应.髋关节功能按Harris评分:Pipkin I型平均85分,Ⅱ型90分,Ⅳ型77分.按Thompson-Epstein评价标准:优3例,良8例,一般1例和差1例,优良率84.6%.结论:聚-DL-乳酸可吸收螺钉是治疗Pipkin骨折安全有效的内固定材料.     

Minimally invasive removal of a deep-positioned cannulated screw from the femoral neck: A case report

BACKGROUNDClinical femoral neck fracture is common. Based on patient age and fracture type, different surgical methods can be selected, including cannulated screw fixation of the femoral neck and artificial total hip joint or semi-hip joint replacement. When patients with femoral neck fracture are treated with cannulated screw fixation, a cannulated screw may be positioned too deep. The excessively deep-placed screw is difficult to remove and causes major trauma to the patient.CASE SUMMARYA patient with poliomyelitis and femoral neck fracture was treated with a cannulated screw that was placed too deep. A self-made auxiliary tool (made of a steel sternal wire) was used to remove the cannulated screw near the pelvic cavity.CONCLUSIONThe depth of the cannulated screw can be estimated before screw placement using an improved hollow screwdriver with a scale mark, thus improving the safety of screw placement and facilitating clinical use.     

髋关节前方横切口与S-P切口治疗股骨头PipkinⅠ型、Ⅱ型骨折疗效比较

[目的]探讨比较髋关节前方横切口与S-P切口治疗股骨头PipkinⅠ型、Ⅱ型骨折的治疗方法与愈后.[方法]回顾性分析采用髋关节前方横切口与S-P切口治疗股骨头PipkinⅠ型、Ⅱ型骨折42例患者的临床资料.其中前方横切口入路行切开复位,可吸收螺丝钉内固定治疗19例（A组）,S-P切口入路切开复位,可吸收螺丝钉内固定治疗23例（B组）.对两组手术入路患者术中情况,术后功能及术后并发症等情况进行比较.[结果]两组的切口长度分别为（9.3±1.6）、（16.6±1.7）cm.手术时间分别为（60.7±10.6）、（85.4±13.1）min,出血量分别为（100.5±43）、（373.9±96）mL,两组间比较差异均有统计学意义（P〈0.01）.患髋功能评定采用Harris评分法：A组为（85.5±5.3）分,B组为（83.2±6.6）分,差异有统计学意义（P〈0.01）.A组发生并发症2例,B组5例,差异无统计学意义（P〉0.05）.两组影像学愈合时间：A组（14.0±1.4）周,B组（14.7±1.1）周,差异无统计学意义（P〉0.05）.[结论]对于股骨头PipkinⅠ型、Ⅱ型骨折手术治疗,髋关节前方横切口入路具有切口短,出血少,手术时间短,髋关节功能恢复好等优势,具有临床应用价值.     

经皮空心钉固定治疗小儿股骨颈骨折的疗效观察

目的:观察C型臂引导下闭合复位空心钉固定治疗小儿股骨颈骨折的疗效.方法:回顾性分析本院2000年1月～2003年12月股骨颈骨折11例的临床资料.对3例骨折移位不明显者采用原位1枚空心钉固定;对8例明显移位成角者采用2枚空心钉固定3例,采用1枚空心钉 克氏针固定5例.结果:全部病例骨折处愈合良好,无1例发生股骨头髓板早闭及髋内翻,仅1例股骨头轻度坏死.结论:空心钉固定治疗小儿股骨颈骨折疗效好,操作方法简单,损伤小,并发症少,建议推广应用.     

Treatment of lower part of glenoid fractures through a novel axillary approach: A case report

BACKGROUNDBased on the location and size of the fracture block, open reduction and internal fixation can be employed or assisted for shoulder arthroscopy in the treatment of glenoid fractures. However, the treatment of lower part of glenoid fractures through a novel axillary approach has not been reported so far. CASE SUMMARYA 22-year-old right-handed man was transferred to our outpatient clinic because of right shoulder injury during a traffic accident. X-ray examination after admission suggested the fracture of the lower part of the right glenoid and an ipiselial proximal humeral fracture. Three-dimensional (3D) computed tomography (CT) further suggested that the size of the fracture block of the lower part of the right glenoid was 3.4 mm × 16.2 mm. The patient was diagnosed as the fracture of the lower part of the glenoid, also known as bony Bankart lesion without shoulder dislocation. After general anesthesia, the patient was surgically treated with the open reduction internal fixation through a novel axillary approach. 3D CT and shoulder joint function were reexamined at 12 mo of follow-up, showing acceptable recovery.CONCLUSIONThis case report describes a novel axillary approach adopted in an open reduction with cannulated screw and wire anchor internal fixation. After a follow-up for more than 12 mo, 3D CT and shoulder joint function examinations display a good recovery.     

骨质疏松性髋部骨折:不同金属植入物治疗的比较

背景:金属植入物内固定治疗年轻股骨颈骨折患者效果较好,但有关金属植入物治疗老年股骨颈骨折患者的效果较少见报道.目的:比较采用不同金属植入物治疗老年骨质疏松性髋部骨折的效果.方法:选择本院1998-01/2008-12老年骨质疏松性髋部骨折患者237例,年龄60～96岁.采用空心加压螺钉置入内固定治疗32例,解剖钢板置入内固定23例,动力髋螺钉置入内固定41例,双极股骨头置换111例,人工全髋关节置换30例.比较各组并发症发生率及髋关节功能恢复情况.结果与结论:空心加压螺钉、解剖钢板、动力髋螺钉置入内固定治疗并发症发生率均高明显于双极股骨头置换、全髋关节置换治疗(P<0.01);空心螺钉组、股骨近端解剖钢板、动力髋螺钉置入内固定治疗优良率明显低于双极股骨头置换及全髋关节置换治疗(P<0.001,P<0.01).结果提示老年骨质疏松性股骨颈骨折应首选人工关节置换(双极股骨头置换或全髋置换),对Garden型可选用空心螺钉固定,转子间骨折Jensen-EvansⅠ～Ⅱ型可选用动力髋螺钉及股骨近端解剖型钢板置入内固定;Jensen-EvansⅡ～Ⅲ型骨质疏松性转子间骨折关节置换是理想的选择.     

髋关节后脱位伴股骨头骨折：分型与修复方式的影响

背景：髋关节后脱位伴股骨头骨折易导致股骨头坏死、异位骨化、骨性关节炎、深静脉血栓等一系列并发症，应根据不同骨折类型针对性地采用不同的治疗方法。 目的：探讨影响髋关节后脱位伴股骨头骨折疗效及并发症的各种因素。 方法：解放军第101医院自2004年9月至2010年5月共收治28例髋关节后脱位伴股骨头骨折患者，按股骨头骨折Pipkin分型、不同手术入路及受伤至手术治疗时间分组，以X射线平片及髋关节功能恢复情况（Epstein法）评估疗效，并记录并发症发生情况。 结果与结论：28例获得随访，随访时间平均2.8年（1-5年）。根据Epstein法评估疗效，优6例，良12例，可7例，差3例，优良率达64%。其中PipkinⅠ、Ⅱ型患者治疗效果较好（优良率100%，78%），并发症发生也不多（发生率17%，22%），但 Pipkin Ⅲ、Ⅳ型患者治疗效果不佳，尤其是 Pipkin Ⅳ型患者治疗后的优良率仅20%，且并发症发生率达80%。采用Smith-Peterson前方入路患者及K-L后方入路患者并发症发生率比较差异无显著性意义（P〉0.05）。股骨头骨折至手术的时间48 h的3组患者并发症发生率比较差异无显著性意义（P〉0.05）。结果提示，股骨头骨折应根据分型选择治疗方法，其预后取决于患者的年龄、治疗时间、骨折脱位类型、治疗方法以及预防并发症的相关措施。     

Bold螺钉治疗急性腕舟骨骨折

目的：评价Bold螺钉内固定治疗急性腕舟状骨骨折的临床疗效。方法：对18例急性腕舟状骨骨折采用切开复位、Bold螺钉内固定的治疗方法,其中男性17例,女性1例,年龄17～48岁,平均32岁。Herbert分型A1型1例,A2型7例,B1型3例,B2型5例,B3型2例,分别采用常规掌侧及掌、背侧小切口入路手术,随访6～18个月,平均12个月。结果：随访18例均一期愈合,愈合时间8～10周,平均9.2周。按Krimmer等评分：优10例,良6例,可2例。结论：切开复位、Bold螺钉内固定是治疗急性腕舟状骨骨折的有效方法,手术切口小,愈合率高,骨折解剖复位,断端加压固定,无需取出。     

改良撬拨闭合复位内固定修复复杂股骨颈骨折及内固定植入物的选择

背景：股骨颈骨折后常用闭合复位内固定进行手术治疗,但仍有一部分患者常规手法闭合复位失败。目的：观察复杂股骨颈骨折运用改良撬拨闭合复位内固定的临床疗效。 方法：收集2011年12月至2013年10月期间上海交通大学附属第六人民医院骨科复杂股骨颈骨折住院患者36例,经过常规手法复位失败一两次后,采用改良的撬拨闭合复位空心加压螺钉内固定。根据年龄、骨折类型、骨密度状况选择动力髋螺钉加1枚空心螺钉（n=17）或3枚空心螺钉（n=19）内固定。内固定后随访采用Harris评分评价临床疗效。 结果与结论：所有36例患者均得到随访,随访时间6个月-2年,平均15.5个月。发生股骨头坏死患者3例,骨折延迟愈合2例。Garden复位质量评价：Ⅰ级23例,Ⅱ级11例,Ⅲ级2例,Ⅳ级0例,Ⅰ级、Ⅱ级占患者总数的94.4%。Harris评分情况：优22例,良7例,中3例,差4例,优良率80.56%。且采用动力髋螺钉加空心螺钉或3枚空心螺钉进行内固定的患者的髋关节Harris评分接近（P〉0.05）。因此,对于常规复位失败的复杂股骨颈骨折,建议尝试改良的撬拨闭合复位法,内固定采用动力髋螺钉或空心螺钉对疗效无明显影响。     

Herbert螺钉治疗肱骨小头骨折应用分析

目的 评价Herbert 螺钉治疗有移位的肱骨小头骨折的优越性.方法 自2005年3月以来应用Herbert螺钉治疗有移位的肱骨小头骨折11例,按Bryan-Morrey肱骨小头骨折分型:Ⅰ型7例,Ⅱ型1例,Ⅲ型3例.结果 经平均随访3年 8个月,术后功能按Mayo评分优7例,良4例,大多数患者完全恢复正常,无并发症.结论 Herbert 螺钉治疗肱骨小头骨折能提供牢固的内固定,大多数患者肘关节功能恢复良好,稳定无疼痛.在处理这类骨折中,本治疗方法 较常规方法 具有明显的优越性.     

透视导航下经皮螺钉置入内固定髋臼骨折18例

背景:移位的髋臼骨折常需要切开复位内固定手术治疗.广泛的手术暴露可以产生许多并发症.经皮螺钉置入内固定髋臼骨折可以减少这些并发症.计算机辅助透视导航技术可以提高螺钉固定的精确度以及减少X射线透视的时间.目的:评估在透视导航指引下经皮螺钉置入内固定髋臼骨折的临床应用结果.方法:使用C臂透视导航设备对伴有20个髋臼损伤的18例患者行导航下髋臼骨折经皮螺钉置入内固定.采集图像后在导航下按照损伤部位分为髋臼前柱骨折和髋臼后柱骨折,分别采用不同的空心螺钉固定.置入后第2天开始进行静力性肌肉收缩以及限制性主动和被动关节活动,4周后开始部分负重锻炼.观察螺钉置入时间,验证螺钉位置偏差,观察螺钉生物相容性及置入后不良反应,随访时进行d'Aubigne and Postel评分.结果与结论:放置空心螺钉30枚.置入中每枚空心螺钉放置平均时间为24.1 min,X射线图像采集平均27.6 s.将导航下图像与真实C臂机射片进行对照,螺钉置入后验证位置平均偏差为1.5 mm,平均偏差角度为2.25°.置入后1例患者出现股神经损伤症状,2个月后恢复,该神经症状与髋臼骨折使用有限切开复位有关,与螺钉置入固定无关.置入后无感染及内固定失败.d'Aubigne and Postel评分优13例,良4例,一般1例,优良率94%.结果证实,对于无移位或移位后能够闭合复位或有限切开复位的髋臼骨折透视导航下经皮螺钉置入内固定技术能够成为一种安全有效的骨折固定方法.     

Treatment for subtrochanteric fracture and subsequent nonunion in an adult patient with osteopetrosis: A case report and review of the literature

BACKGROUNDAs a congenital metabolic bone disease caused by defective osteoclastic resorption of immature bone, osteopetrosis is characterized by diffused sclerosis of bones, brittle bones, easy fracturing, narrow medullary canals, and a weak fracture healing ability. At present, clear standards and principles for the treatment of fractures in patients with osteopetrosis are lacking. Non-operative treatment can prevent fracture hematoma and preserve the blood supply to the bone fragments, while being associated with frequent failures and higher mortality rates. Meanwhile, closed reduction and internal fixation with intramedullary nail (CRIF + IMN) approaches can also protect blood supply to the fracture site. However, IMN cannot be used for the vast majority of patients with osteopetrosis due to the narrowing of medullary canals. Thus, open reduction and internal fixation with plate remains the most appropriate surgical method for treating fractures in patients with osteopetrosis, but this approach is complicated by the lack of intramedullary hematopoiesis in such patients. Fracture healing primarily depends on the blood supply to the external periosteum. Open reduction can also easily destroy the periosteum and cause delayed fracture healing or even nonunion; however, CRIF may be the most practical approach. As a result, it would be prudent to solve the difficulty of drilling during the operation and the problem of postoperative nonunion.CASE SUMMARYIn 2018, we treated an adult patient with osteopetrosis presenting with a subtrochanteric fracture. The fracture was fixed using a femoral locking compression plate. Because of delayed consolidation, at 12 mo postoperatively the patient was further treated with platelet-rich plasma (PRP) combined with radial extracorporeal shock wave therapy (rESWT). Antero-posterior and lateral radiographs obtained at the latest follow-up (10 mo) showed that the callus had grown at the original fracture site, and the medial fracture line almost disappeared. CONCLUSIONOsteosynthesis remains the first choice of treatment approach for fractures in patients with osteopetrosis, especially peritrochanteric fractures. Preoperative preparation is necessary to avoid risks such as drill bit breakage and iatrogenic fracture during the operation. Moreover, fractures in a patient with osteopetrosis present with a high risk of delayed union and nonunion, which can be potentially cured with PRP + rESWT.     

切开复位内固定术治疗髋臼复杂骨折疗效分析

目的探讨复杂髋臼骨折的手术治疗及提高疗效的方法。方法总结2004年6月至2009年6月对36例复杂髋臼骨折患者的手术治疗经验。根据Letournel-Judet分型:双柱骨折13例,横形伴后壁骨折9例,"T"形骨折6例,后柱伴后壁骨折6例,前柱伴后壁骨折2例。分别采用Kocher-Langenbeck入路、髂腹股沟入路、前后联合入路进行切开复位骨盆重建钢板内固定治疗。结果 36例患者获访,复位优良率91.6%。临床疗效评定优良率为80.5%。术后异位骨化、创伤性关节炎各2例,脂肪液化、股骨头坏死各1例,无手术死亡及骨不愈合发生。结论对于复杂髋臼骨折,术前正确判断骨折类型及移位方向,选择适当的手术时机及入路,以及术中良好的复位及固定是治疗的关健。     

Periprosthetic fracture fixation of the femur following total hip arthroplasty: A review of biomechanical testing – Part II

BackgroundPeriprosthetic femoral fracture is a severe complication of total hip arthroplasty. A previous review published in 2011 summarised the biomechanical studies regarding periprosthetic femoral fracture and its fixation techniques. Since then, there have been several commercially available fracture plates designed specifically for the treatment of these fractures. However, several clinical studies still report failure of fixation treatments used for these fractures.MethodsThe current literature on biomechanical models of periprosthetic femoral fracture fixation since 2010 to present is reviewed. The methodologies involved in the experimental and computational studies of periprosthetic femoral fracture fixation are described and compared with particular focus on the recent developments.FindingsSeveral issues raised in the previous review paper have been addressed by current studies; such as validating computational results with experimental data. Current experimental studies are more sophisticated in design. Computational studies have been useful in studying fixation methods or conditions (such as bone healing) that are difficult to study in vivo or in vitro. However, a few issues still remain and are highlighted.InterpretationThe increased use of computational studies in investigating periprosthetic femoral fracture fixation techniques has proven valuable. Existing protocols for testing periprosthetic femoral fracture fixation need to be standardised in order to make more direct and conclusive comparisons between studies. A consensus on the ‘optimum’ treatment method for periprosthetic femoral fracture fixation needs to be achieved.     

Imaging observation of percutaneous compression plate use in promoting femoral neck fracture healing

ObjectiveTo examine the imaging evidence of the use of percutaneous compression plate (PCCP) in promoting femoral neck fracture healing compared with cannulated screws (CS).MethodsThis retrospective study enrolled patients with femoral neck fractures undergoing internal fixation procedures. The patients were divided into a PCCP group and a CS group with imaging as the primary outcome and Harris hip score (HHS) as the secondary outcome.ResultsThis study included 162 patients: 80 in the PCCP group and 82  in the CS group. There were no significant differences between the patients in their preoperative baseline characteristics. Patient follow-up ranged from 24–56 months (mean 30.7 months). Differences in reduction quality, screw slipping, neck shortening and avascular necrosis (AVN) were not significant between the two groups. There were significant differences between the treatment groups in bone absorption, nonunion, healing time, screw withdrawal and fixation failure in favour of the PCCP group. Postoperative HHS at 6 and 12 months were significantly better for the PCCP group than the CS group, but the differences were not significant at 24 months and last follow-up.ConclusionStable internal fixation with dynamic compression was the key to PCCP promoting femoral neck fracture healing.     

动力髋螺钉与防旋阻挡钉联合修复不稳定型股骨转子间骨折

背景：严重的股骨转子间骨折,其抗旋转能力差,单单动力髋螺钉内固定容易失败.如内固定后出现股骨头塌陷、股骨颈短缩、小转子内侧失稳髋内翻、头颈旋转、头颈切割穿钉、钢板拨钉及钢板断裂等现象.故对于不稳定型股骨转子间骨折,动力髋螺钉内固定有一定的局限性.目的：探讨动力髋螺钉联合防旋阻挡钉置入内固定对不稳定型股骨转子间骨折的修复效果.方法：选取96例不稳定型股骨转子间骨折患者,分别实施内固定治疗,其中采用动力髋螺钉组48例,动力髋螺钉联合防旋阻挡钉组48例.从手术时间、术中出血量、X射线暴露次数、骨折愈合时间、内固定后Harris髋关节评分及内固定后并发症等方面进行对比评估.结果与结论：内固定后随访时间为18-36个月.动力髋螺钉组和动力髋螺钉联合防旋阻挡钉组在手术时间、术中出血量、X射线暴露次数、骨折愈合时间方面比较差异无显著性意义（P＞0.05）.动力髋螺钉联合防旋阻挡钉组内固定后髋关节评分（Harris评分）高于动力髋螺钉组（P＜0.05）.动力髋螺钉组内固定后并发症发生率（14％）显著高于动力髋螺钉联合防旋阻挡钉组（4％,P＜ 0.05）.提示单纯动力髋螺钉置入内固定修复不稳定型股骨转子间骨折并发症较多,失败率较高;而动力髋螺钉联合防旋阻挡钉能重建股骨后内侧结构,弥补动力髋螺钉的缺点和不足,对不稳定型股骨转子间骨折的修复有重要价值.     

Resection with limb salvage in an Asian male adolescent with Ewing’s sarcoma: A case report

BACKGROUNDEwing’s sarcoma is a highly malignant primary bone tumor that commonly affects children. For young patients, multidisciplinary treatment and limb salvage are recommended, and surgical plans considering the growth potential and bone activity after tumor resection are essential.CASE SUMMARYAn 11-year-old Asian boy had a 1-mo history of a right-sided limping gait. Imaging revealed a proximal tumor with bone destruction and physeal involvement over the right femoral neck. He was diagnosed with stage IV (T1N0M1aG3) Ewing’s sarcoma with bilateral lung metastases. Neoadjuvant chemotherapy decreased the tumor size and confined it to the metaphyseal region. The patient underwent four stages of surgery: wide tumor excision plus reconstruction with vascular fibular bone graft plus internal fixation; repeat open reduction and internal fixation; femoral lengthening with orthosis after physeal maturity; and orthosis removal and bone elongation (approximately 6 cm). Following surgery, he could walk without discomfort and had almost equal-sized bilateral femoral heads, indicating physis preservation. The surgery was successful, and normal femoral head growth was achieved after complete remission. The patient was able to resume normal activities with equal length of the bilateral lower limbs.CONCLUSIONTumor treatment and reconstruction following resection are important in skeletally immature patients with Ewing’s sarcoma to improve quality of life.     

切开复位内固定与桡骨头切除治疗桡骨头MasonⅢ、Ⅳ型骨折的比较

【目的】评价并比较MasonⅢ型或Ⅳ型桡骨头骨折行切开复位内固定术及桡骨头切除术的治疗效果,为选择桡骨头骨折治疗方法提供参考。【方法】桡骨头骨折21例,行桡骨头切除9例（Ⅲ型5例,IV型4例）;切开复位钢板螺钉内固定12例（Ⅲ型7例,Ⅳ型5例,其中钢板螺钉内固定9例,螺钉内固定3例）。术后根据肘关节活动度、肘关节提携角变化和桡骨移位、VAS疼痛评分、患者对治疗效果的主观评价和Broberg＆Morrey肘关节功能评分等进行疗效评定。【结果】平均随访时间29个月（12～60个月）,所有患者骨折均愈合。切开复位内固定组及桡骨头切除组肘关节屈曲伸直弧度（130°±22．9°VS78°±30．6°）;提携角变化（2°±2．1°VS9°±5．6°）、桡骨移位[（0．4±0．3）mmvs（2．7±1．6）mm）]、VAS疼痛评分[（0．9±0．2）分VS（4．6±2．3）]和患者满意度[（9．3±1．4）分VS（6．9±2．6）分],比较差异均有统计学意义（Pd0．01）;Brobergi＆Morrey肘关节功能评分：切开复位内固定组平均（92．6±13．4）分,优7例,良3例,可2例,差0例;桡骨头切除组平均（70．8±19．6）分,优1例,良2例,可3例,差3例。两组比较,差异有统计学意义（P〈0．01）。【结论】切开复位内固定是桡骨头MasonⅢ型、Ⅳ型骨折,可以获得比桡骨切除更好的肘关节功能,较少的并发症,注意术中术后的正确处理是手术成功的关键。