目的 探讨不同类型桡骨头骨折的治疗方法及疗效.方法 2004年2月至2008年4月收治的57例桡骨头骨折的患者,根据Mason分型,其中Ⅰ型12例、Ⅱ型24例、Ⅲ型19例、Ⅳ型2例.针对不同类型骨折选择相应的治疗方法.结果 术后随访时间为18～48个月,平均28.4个月.根据Broberg和Morrey肘关节功能评分标准评定:优29例,良18例,可9例,差1例；优良率为82.5％.术后无一例发生肘部感染和神经损伤,1例发生骨不连,4例有创伤性关节炎表现,3例发生异位骨化,1例有肘关节不稳定表现.其中MasonⅢ、Ⅳ型骨折患者术后患侧肘关节活动范围小于健侧,差异有统计学意义(P＜0.05).结论 单纯MasonⅠ型骨折可行保守治疗；Ⅱ型骨折治疗需慎重,存在肘关节不稳定的需行切开复位内固定术；Ⅲ、Ⅳ型骨折可行切开复位内固定或桡骨头置换术,同时注意修补或重建韧带以稳定肘关节,对桡骨头切除要谨慎.%Objective To investigate the treatment options for different types of radial head fractures and report the clinical outcomes. Methods Retrospective analysis was carried out in 57 patients with radial head fractures treated from February 2004 to April 2008.According to Mason classification,there were 12 cases of Mason typo Ⅰ fractures,24 cases of Mason type Ⅱ fractures,19 cases of Mason type Ⅲ fractures and 2 cases of Mason type Ⅳ fractures.Fracture management was based on the type of injury. Results The average followup was 28.4 months (range,18 to 48 months).Functional outcomes were assessed according to Broberg and Morrey score systems.Elbow function was rated excellent in 29 cases,good in 18 cases,fair in 9 cases and poor in 1 case.Excellent and good results were found in 82.5％ of the cases.As to complications,there were 1 case of non-union,4 cases of traumatic ostecarthritis,3 cases of beterotopic ossification,and 1 case of elbow instability.Infection as well as nerve injury was not found in any case.In Mason type Ⅲ Ⅳ fractures significant difference was found in the range of motion between the affected joint and the contralateral one( P ＜0.05). Conclusion Conservative treatment is indicated in the patients with Mason type Ⅰ fractures.Open reduction and internal fixation (ORIF) was required in patients with Mason type Ⅱ fractures combined with elbow instability.ORIF or arthroplasty can be considered in patients with Mason type Ⅲ and Ⅳ fractures.Care should be taken to repair or reconstruct ligament injury to ensure elbow stability.Radial head excision should be considered cautiously.
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