桡骨头和桡骨颈骨折

桡骨头和桡骨颈骨折的生物力学研究日益受到重视。治疗上,近年来倡导对合适病人行切开复位内固定,Herbert钉内固定的近期疗效优于保守治疗和桡骨头切除术,Swonson假体的应用仍有较大争议。桡骨头-肱骨小头位摄片可提高桡骨头无移位骨折的诊断率。本文还介绍了各家分类的特点和合并症的处理。     

应用人工桡骨头假体置换治疗桡骨头粉碎骨折的研究

根据桡骨头的解剖形态和生理功能，用一定硬性和韧性的超高分子量聚已烯材料，做成不同大小、长短的人工桡骨头假体。临床上主要治疗桡骨头粉碎骨折。手术暴露取肘后外侧斜行切口，从肘肌与尺侧腕伸肌间切开肱桡关节囊，部分切断环状韧带，摘除粉碎的桡骨头。在桡骨上端截骨，并扩大其髓腔。将备好的桡骨头假体柄插入桡骨上端髓腔内，用骨水泥加固。作者从１９８９年起采用这种假体治疗桡骨头粉碎骨折３０例，经临床观察和生物力学检测，证明假体生物相容性良好，患肢功能恢复满意，疗效优良率为８６．７％，早期手术优良率为９５．８％。未发现假体变形、折断现象。假体置换稳定，避免了桡骨短缩上移和下桡尺关节半脱位等弊病。     

成人桡骨头切除术后临床分析

目的：探讨成人桡骨头切除术后肘、腕关节的生物力学变化及影响临床疗效的因素。方法：对成人桡骨头粉碎性骨折、骨片分离移位及陈旧性骨折畸形愈合的病人行桡骨头切除２９例。结果：１７例获２～１２年随访,发现有１４例前臂肌力减弱,１３例肘关节屈伸度减少,１１例前臂旋转受限,８例携带角增大,７例桡骨上移,４例发生肘、腕关节骨性关节炎。结论：成人桡骨头切除术后肘关节屈伸度及前臂旋转功能虽有不同程度受限,但可满足日     

桡骨头骨折的治疗及其疗效分析

目的：根据桡骨头在前臂的生物力学作用，对桡骨头骨折不同的治疗方法及结果进行研究，寻求一种合理、有效的桡骨头骨折的治疗方法。方法：对49例桡骨头骨折的病人随访调查，对非手术治疗的14例（MasonⅡ型），切开复位内固定治疗的29例（Mason Ⅱ型19例，Mason Ⅲ型10例），及桡骨头切除的6例按照Geel和Palmer评分标准对其结果进行评估。结果：平均随访2．8年（2－5．5年）。非手术治疗的优良率为85．7％（12／14），切开复位内固定的优良率为78．6％（22／29），桡骨头切除的优良率仅为33．3％（2／6），总率为73．5％（36／49）。结论：对桡骨头骨折应尽量通过手术或非手术方法恢复其正常解剖关系，保持前臂矩形框架生物力学的稳定，对桡骨小头切除要慎重。     

应用生物力学方法探讨桡骨小头切除术晚期并发症的原因

自１９７８年，共施行桡骨头切除术３７例。２７例获２年以上随访。肘外翻畸形，肘关节慢性不稳定，桡骨干上移和下尺桡关节脱位是主要并发症。作者用２０只新鲜上肥标本进行生物力学实验，发现肘关节内侧副韧带损伤，有间膜撕裂狎和下尺桡关节痈位是引起或加重并发症的主要原因。其中内侧副韧带损伤是最重要的原因。同时，临床上也以桡骨头损伤合并内介副韧带损伤多见。作者强调：桡骨头切除时，应考虑上术三种软组织损伤是否存在及     

桡骨头置换术进展

桡骨头是肘关节的重要组成部分,参与肘关节活动,维持肘关节稳定。桡骨头置换术既可用于桡骨头骨折的一期治疗,也可用于桡骨头切除后肘关节不稳定或桡骨头畸形愈合后的补救性治疗,使肘关节获得完整的外侧支撑,维持良好的稳定性。目前桡骨头假体种类很多,但尚无文献能够证明哪种假体更优。合适的假体直径和高度是桡骨头置换术取得满意疗效的关键因素。桡骨头置换术中短期疗效满意,但长期疗效仍需进一步观察总结。     

桡骨头骨折的分型及治疗研究进展

桡骨头是肘关节重要的组成部分,对维持肘关节稳定有重要作用,与肘关节其他构成之间有复杂的运动关系。桡骨头骨折在临床上非常常见,骨折的分型决定了治疗方式的不同及预后。本文对桡骨头骨折的分型进行简要概述,从治疗方法、手术入路及并发症等对桡骨头骨折治疗的研究进展进行综述。     

儿童陈旧孤立性桡骨头脱位的诊断治疗

目的：探讨儿童陈旧孤立性桡骨头脱位的发生机理、诊断与治疗。方法：治疗儿童陈旧孤立性桡骨头脱位9例，将嵌夹于肱桡关节之间的组织，全部一次绕过桡骨头，拨向桡骨头移位侧，利用其移位后的张力，限制桡骨头再移位。结果：术后随访平均13个月，7例肘关节伸屈前臂旋转功能正常；1例前臂旋转功能受限30*；1例桡骨头半脱位。结论：孤立性桡骨头脱位与扭旋暴力有关。早期诊断，解除阻碍复位因素，疗效满意。     

桡骨头脱位的诊断与治疗

桡骨头脱位的诊断与治疗济南山东中医学院（２５００１４）毕荣修，于光华单纯先天性与单纯创伤性桡骨头脱位较少见，二者易发生误诊。自１９８７年～１９９４年我科共治疗两种脱位共９例，本文就先天性与创伤性桡骨头脱位有关诊断、鉴别诊断及治疗问题作一讨论。临床资料...     

关于“桡骨头”及“桡骨小头”规范用词的看法

近年来,经常在查看肘部创伤的文献时,发现桡骨头与桡骨小头两名词混用的情况[1-2]。这两个名词到底有无区别?二者是指桡骨上的一个部位还是不同部位?若二者无区别,为什么严谨的科研写作,会用两个名词来表述同一种意思呢?于是笔者钩沉二者在文献中引用的进展。现行《系统解剖学》教材[3]中对桡骨头的定义是"上端膨大称桡骨头,头上面的关节凹与肱骨小头相关节;周围的环状关节面与尺骨相关节"。早期文献[4]定义桡骨头较明确,以"桡骨Theradius"条目下引出"上端分头颈粗隆三部分:头为圆柱形,上有凹关节面以接肱骨小头,四周有关节面,内份较阔以接尺骨之桡骨切迹,余份较窄,绕以环状韧带";而记载有"桡     

桡骨小头切除晚期并发症的原因及机制探讨

目的：研究桡骨小头切除后晚期并发症产生的原因、发病机制和预防措施。方法：对２８例桡骨小头切除术后进行２年以上随访。同时对２０例新鲜上肢标本进行生物力学检测。结果：发现桡骨小头切除术后的晚期并发症有肘外翻畸形、创伤性关节炎、桡尺远侧关节脱位等。肘关节内侧副韧带损伤、骨间膜撕裂伤和桡尺关节远侧脱位是桡骨小头切除术后引起或加重晚期并发症的主要原因。结论：桡骨小头切除时,应考虑上述三种组织损伤是否存在及对预后的影响;桡骨小头切除在青少年患者应视为禁忌     

Elbow joint kinematics after excision of the radial head.

The contribution of the radial head to elbow joint kinematics was studied in 7 osteoligamentous elbow preparations. During unloaded flexion and extension, radial head excision induced a maximum varus displacement of 1.6 degrees with 20 degrees of joint flexion and a maximum external rotation of 3.2 degrees at 110 degrees of flexion. With application of a 0.75-Nm load, radial head excision induced a maximum laxity of 3.3 degrees at 20 degrees of flexion in forced varus and a maximum laxity of 8.9 degrees at 10 degrees of flexion in forced external rotation. No laxity was observed in forced valgus or internal rotation. The results were independent of the rotation of the forearm. This study indicates that the radial head acts as stabilizer to the elbow joint in forced varus and in forced external rotation. The results suggest that fractures of the radial head cannot be treated by simple excision without altering the basic kinematics of the elbow joint.     

Valgus stability of the elbow. A definition of primary and secondary constraints

The stabilizing structures of the elbow that resist valgus stress were studied with a tracking device in a model simulating active motion and muscle activity. By varying the order of serial release of the medial collateral ligament complex and removal of the radial head, each structure's contribution to valgus stability against the effect of gravity was determined. In the otherwise intact elbow, absence of the radial head does not significantly alter the three-dimensional characteristics of motion in the elbow joint. Isolated medial collateral release, on the other hand, causes increases in abduction rotation of about 6 degrees-8 degrees in magnitude. Releasing both structures results in gross abduction laxity and elbow subluxation. This study defines the medial collateral ligament (MCL) as the primary constraint of the elbow joint to valgus stress and the radial head as a secondary constraint. This definition facilitates the proper management of patients with radial head fractures and MCL disruption. The comminuted radial head fracture uncomplicated by MCL insufficiency should be treated by excision without the need for an implant and without concern of altering the normal kinematics of the elbow.     

Replacement of the radial head in the treatment of unstable elbow fractures

The use of a radial head prosthesis for the treatment of fractures of the radial head associated with gross instability of the elbow is described. Seventeen fractures occurring in seventeen patients treated at the Toronto East General Hospital from 1966 to 1979 are analysed. Instability of the elbow occurs when fracture of the radial head is combined with dislocation of the elbow, fracture of the proximal ulna, fracture of a major portion of the coronoid process and rupture of the medial ligament.Stability can be restored in these injuries by inserting a radial head prosthesis which acts as a joint spacer. A metallic prosthesis was used in 15 patients and a silastic cap in 2. The results of this method of treatment for a difficult problem are good.We are not advocating the routine use of a prosthesis for simple fractures of the radial head. It is indicated for injuries where stability is poor after excision of the radial head. There is little information in the literature regarding the use of a prosthesis for radial head fractures.     

Radio-ulnar dissociation. A review of twenty cases.

The results of treatment were reviewed for twenty patients who had sustained concomitant injuries of the lateral compartment of the radiohumeral joint and the ipsilateral distal radio-ulnar joint. The ages of the patients ranged from eight to seventy-four years (average, thirty-five years) and the duration of follow-up ranged from four months to twenty-seven years (average, 113 months). In fifteen patients, the injury of the wrist was diagnosed after a mean delay of seven years and eleven months (range, one month to twenty-six years). In all fifteen, the radial head injury was treated by excision, either initially or after some delay. After excision of the radial head, all fifteen patients complained of severe pain at the distal radio-ulnar joint. The results, on the basis of elbow and wrist scores of fair or better without complications, were satisfactory in only three patients. In the remaining five patients, in whom the injuries of both the elbow and the wrist had been identified at the initial evaluation, the radial head was either preserved or replaced. The results, on the basis of elbow and wrist scores of fair or better, were graded as satisfactory in four of these patients. Our data show that any injury to the lateral side of the elbow should prompt a careful evaluation of the ipsilateral distal radio-ulnar joint for associated instability.     

Radial head fractures and their effect on the distal radioulnar joint. A rationale for treatment.

Nineteen patients were treated with open reduction and internal fixation for radial head fractures. Open reduction and internal fixation was performed to avoid radial head excision and the possible development of distal radioulnar joint dysfunction. Follow-up observation, which averaged 11.7 months, revealed that no patient developed wrist pain. Range of motion of the elbow and forearm was found to be complete in 14 patients and minimally restricted in four. Fourteen patients were pain free with full activity, and four had mild to moderate pain after heavy labor. One patient subsequently required radial head excision. Based on these findings and the authors continued disappointment with treatment of distal radioulnar joint dysfunction caused by proximal radial migration after radial head excision, the authors recommend early open reduction and internal fixation of all displaced or angulated radial head fractures.     

重建肘关节外翻稳定性的生物力学研究

目的　评价肘关节桡骨头 (radial head,RH)切除、尺侧副韧带 (medial collateral ligament,MCL )损伤以及 RH假体置换、MCL重建后的外翻稳定性。　方法　新鲜成人尸体上肢标本 12侧 ,制成肘关节“骨 -韧带”标本 ,在2 N· m的外翻力矩作用下 ,分别在肘关节 0°、30°、6 0°、90°和 12 0°伸屈时 ,测量肘关节外翻松弛度 :1完整肘关节(n=12 ) ;2 MCL切断 (n=6 ) ;3RH切除 (n=6 ) ;4 MCL切断 +RH切除 (n=12 ) ;5 RH假体置换 (n=6 ) ;6 MCL重建(n=6 ) ;7RH假体置换 +MCL重建 (n=12 )。用 SPSS 10 .0统计软件包作方差分析 ,比较各组的外翻稳定性。　结果　完整肘关节的平均外翻松弛度最小 ;RH切除后 ,外翻松弛度增大 ;单纯 MCL切断 ,外翻松弛度大于单纯 RH切除 (P<0 .0 1) ;MCL切断 +RH切除 ,外翻稳定性最差 ;行 RH假体置换 ,对稳定性有改善 ;MCL重建与完整 MCL差异无统计学意义 (P>0 .0 5 ) ;RH假体置换同时重建 MCL ,效果最好。　结论　 MCL是抵抗肘关节外翻应力最主要的因素 ,RH是次要因素。在重建肘关节的外翻稳定性方面 ,MCL的重建比 RH的假体置换更重要。在无条件行 RH假体置换时 ,修复MCL是较好的手术方式。     

冠突骨折及合并桡骨小头粉碎骨折生物力学

[目的]分析尺骨冠突骨折及合并桡骨小头粉碎骨折时肘关节的稳定性。[方法]选取上肢尸体标本8对，测试各种冠突骨折及合并桡骨小头粉碎骨折时肘外翻位移及外旋角。[结果]肘关节稳定性在冠突无骨折、Ⅰ型骨折、Ⅱ型骨折各组间无显著差异，冠突Ⅲ型骨折时显著不稳定。[结论]冠突骨折及合并桡骨小头粉碎骨折在冠突Ⅰ型、Ⅱ型骨折时肘关节稳定，可行桡骨小头切除术，Ⅲ型骨折不稳定，应修复桡骨小头或假体置换，并修复桡侧副韧带。     

What happens to the elbow joint after fractured radial head excision? Clinical and radiographic study at a mean 15-yearfollow-up

Comminuted fractures of the radial head can be treated by radial head excision, open reduction and internal fixation, or radial head replacement. The aim of this study was to evaluate the long-term clinical and radiographic results of 22 patients with an isolated Mason type III fracture of the radial head treated by radial head excision. Mean age at the time of surgery was 36 years and average follow-up was 15 years. Overall outcome at the last follow-up was scored as excellent, good, fair or poor, considering elbow and wrist pain, valgus deformity, elbow and forearm range of motion, and elbow radiographic osteoarthritic changes. At follow-up mean pain score on VAS was was 1, average increase in elbow valgus deformity was 8°, mean flexion of the elbow was 138°, pronation of the forearm averaged 78°, and supination averaged 85°. Degenerative changes were scored as grade 0 in 4 patients, grade 1 in 14 patients, and grade 2 in 4 patients. The overall outcome was excellent in 18 patients and good in 4 patients. When a comminuted radial head fracture is not associated with elbow dislocation or ligamentous injuries, resection of the radial head is a valid surgical option because it is a simple and rapid technique, it has a low learning curve, and it has a high rate of excellent clinical and radiographic long-term results.     

Surgical treatment of the elbow in rheumatoid arthritis

Major disability secondary to involvement of the elbow in RA is uncommon. The indications for surgery are pain and loss of motion unresponsive to medical management. With painful synovitis and decreased function, good results are obtained with synovectomy and radial head excision. Advanced joint destruction may require TEA which produces good to excellent results in 75 to 90 per cent of cases. Arthrodesis of the elbow is not a useful procedure in patients with rheumatoid arthritis and multiple joint involvement. Salvage procedures such as resection arthroplasty and distraction arthroplasty can produce fair results in most cases.