微型螺钉与克氏针治疗桡骨小头粉碎性骨折的疗效比较

目的:比较微型螺钉与克氏针治疗桡骨小头粉碎性骨折的临床疗效。方法:将41例Ⅱ型、Ⅲ型桡骨小头粉碎性骨折患者,随机分为2组,分别采用克氏针固定和微型螺钉固定。对2组患者的关节疼痛评分、肘关节功能、肘关节活动度、肌力、并发症进行比较。结果:2组病例随访2～8年,平均4.1年。两组VAS评分比较,差异无统计学意义(t=2.41,P=0.08)。两组Broberg和Morrey评分比较,螺钉组优于克氏针组。与健侧相比,螺钉组肘关节伸屈度减少度数、前臂旋转减少度数、伸肘肌力减弱百分比、屈肘肌力减弱百分比、旋前肌力减弱百分比、旋后肌力减弱百分比、握力减弱百分比均小于克氏针组(P0.05)。两组患者均未发生肘腕关节炎及明显桡骨上移;共发生骨化性肌炎7例,克氏针组5例,螺钉组2例,两组骨化性肌炎发生率比较,差异无统计学意义(χ2=0.383 4,P=0.535 8)。结论:微型螺钉内固定治疗桡骨小头粉碎性骨折疗效优于克氏针内固定。

Comparison of the curative effects between microscrew and kirschner wire on the treatment of comminuted fracture of capitulum radius

Objective：To compare the clinical curative effects between microscrew and Kirschner wire（K-wire）on the treatment of comminuted fracture of capitulum radius（CFCR）.Methods：41 patients with CFCR of type Ⅱand type Ⅲ were randomly divided into 2 groups,they were fixed with K-wire and microscrew respectively.The joint pain scores,elbow joint functions,elbow motion,muscle strength and complications of the patients were compared between the 2 groups.Results：Patients of the 2 groups were followed up from 2 to 8 years with an average of 4.1 years.There was no statistical difference in the VAS scores between the 2 groups（t=2.41,P=0.08）.Broberg and Morrey scores of screw group were better than those of K-wire group.Compared with the healthy side,reduced degrees of elbow flexion-extension,reduced degrees of forearm rotation,reduced percentages of flexor-extensor strength,reduced percentages of pronator-supinator strength and reduced percentages of grip strength of screw group were lower than those of K-wire group（P0.05）.No elbow arthritis,wrist arthritis and obvious shift-up of radius occurred in the 2 groups.Myositis ossificans occurred in 7 cases totally,5 cases in K-wire group,the others in screw group.There was no statistical difference in the incidence of myositis ossificans between the 2 groups（χ2=0.383 4,P=0.535 8）.Conclusion：Internal fixation with microscrew performs better than internal fixation with K-wire on the treatment of CFCR.