关节镜下撬拨复位内固定治疗桡骨小头骨折

目的探讨关节镜下撬拨复位、经皮克氏针内固定治疗桡骨小头骨折的方法和临床疗效。方法回顾分析2002年8月-2010年5月采用关节镜下撬拨复位、经皮克氏针内固定治疗的15例桡骨小头骨折患者临床资料。其中男11例,女4例;年龄17～41岁,平均29.6岁。左侧6例,右侧9例。致伤原因:摔伤8例,交通事故伤4例,运动损伤3例。受伤至入院时间为1～8 d,平均3.4 d。MasonⅡ型13例,Ⅲ型2例。合并外侧副韧带损伤5例。术后肘关节制动4～6周,6周后拔除克氏针行关节功能锻炼。结果术后即刻X线片检查示骨折均达解剖复位。术后切口均Ⅰ期愈合,无神经、血管损伤及针道感染,内固定物松动等并发症发生。患者均获随访,随访时间12～32个月,平均25个月;术后12周骨折均达骨性愈合。末次随访时,肘关节屈伸活动度为(139.0±7.9)°,与健侧(141.0±5.1)°比较,差异无统计学意义(t=1.146,P=0.271);旋前-旋后活动度为(143.3±7.0)°,与健侧(146.0±4.7)°比较,差异无统计学意义(t=1.948,P=0.072)。肘关节功能根据Mayo肘关节评分标准,为80～100分,平均92分;根据Broberg-Morrey评分标准为85～100分,平均95.2分;获优12例,良3例。结论关节镜下撬拨复位、经皮克氏针内固定治疗桡骨小头MasonⅡ型及部分Ⅲ型骨折,复位准确、固定可靠、并发症少,有利于关节功能恢复。

Arthroscopic poking reduction and internal fixation of radial head fractures

Objective To investigate the methods and effectiveness of arthroscopic poking reduction and percutaneous fixation of radial head fractures.Methods Between August 2002 and May 2010,15 patients with radial head fractures were treated using arthroscopic poking reduction and percutaneous fixation with a Kirschner wire.There were 11 males and 4 females with an average age of 29.6 years(range,17-41years).The locations were left side in 6 cases and right side in 9 cases.Injuries were caused by falling in 8 cases,by traffic accident in 4 cases,and by sports in 3 cases.The average time from injury to admission was 3.4 days(range,1-8 days).Of them,13 patients had Mason typeⅡ,and 2 patients had typeⅢfractures.Accompanying injuries were lateral collateral ligament ruptures in 5 patients.Results The X-ray films confirmed good reduction and fracture healing.Incisions healed by first intention;no complication occurred,such as neurovascular injury,infection,or hardware failure.All patients were followed up 25 months on average(range,12-32 months).The flexion-extension arc was(139.0±7.9)°at last follow-up,showing no significant difference when compared with the contralateral(141.0±5.1)°(t=1.146,P=0.271);the range of pronation and supination was(143.3±7.0)°when compared with the contralateral(146.0±4.7)°(t=1.948,P=0.072). The mean Mayo elbow performance score was 92(range,80-100);the mean Broberg-Morrey score was 95.2(range,85-100);the results were excellent in 12 cases and good in 3 cases.Conclusion Arthroscopic poking reduction and percutaneous fixation with a Kirschner wire offers accurate reduction,reliable fixation,minimal trauma,rapid recovery,and lower morbidity for Mason typeⅡand selective Mason typeⅢradial head fractures.