空心双头加压螺钉在桡骨小头骨折内固定术中的应用

摘要

目的 探讨应用空心双头加压螺钉内固定治疗MasonⅡ、Ⅲ型挠骨小头骨折的可行性及优点.方法 2008年3月至2013年1月,我科90例MasonⅡ、Ⅲ型挠骨小头骨折手术病人,随机分A、B两组,每组45例,A组应用空心双头加压螺钉内固定,B组应用微型T形锁定钛板内固定.术后从肘关节活动度、X线片表现、患者满意度及Broberg和Morrey功能评分等进行疗效评定.结果 所有病例骨折均愈合,愈合时间8～ 15周;无桡骨头坏死发生;A组:手术时间平均50.2分钟(41 ～ 70分钟).术后随访平均24.5个月(12 ～ 48个月).肘关节屈曲伸直弧度平均132.8度;前臂旋前旋后弧度170.5度.Broberg和Morrey肘关节评分平均97.6分,优38例,良6例,可1例,优秀率84.4％.患者满意度平均9.7分.B组:手术时间平均82.2分钟(65～100分钟).术后随访平均25.2个月(12 ～ 50个月).肘关节屈曲伸直弧度平均123.2度,前臂旋前旋后弧度平均152.5度.Broberg和Morrey肘关节评分平均88.4分,优25例,良15例,可5例,优秀率55.5％.患者满意度平均8.2分.两组相比差异有统计学意义(P＜0.05).结论 应用空心双头加压螺钉内固定治疗Mason Ⅱ型及部分MasonⅢ型桡骨小头骨折,有手术操作简便,复位固定满意、利于早期功能锻炼、功能恢复好、并发症少、患者满意度高等优点,是一种较实用的手术方法.%Objective To explore the feasibility and advantages of double-head hollow compression screw in internal fixation of Mason type Ⅱ and Ⅲ radial head fractures.Methods From Mar.2008 to Jan.2013,90 patients with Mason type-Ⅱ and Ⅲ radial head fracture undergoing operation in our department were randomly divided into group A and group B,45 cases for each group.Group A were internally fixed with double-head hollow compression screw,and group B with micro T shape locking titanium plate.The ranges of motion,radiographic findings,patients' satisfaction degrees,and Broberg and Morrey elbow performance scores were compared between the 2 groups.Results 8-15 weeks after the operation,all patients recovered from the fractures without ischemic necrosis.The average operation time was 50.2 min(41-70 min),the patients were followed up average 24.5 month(12-48 months),the mean range of flexion and extension at the elbow was 132.8°,the patients could turn their forearms back average 170.5°,the patients' satisfaction score was 9.7,and the average Broberg and Morrey score was 97.6,showing that 38 cases recovered excellently,6 well,and 1 so so,with a excellent rate of 84.4％ in group A.The average operation time was 82.2 min(65-100 min),the patients were followed up average 25.2 month(12-50 months),the mean range of flexion and extension at the elbow was 123.2°,the patients could their forearms back average 152.5 °,the patients' satisfaction score was 8.2,and the average Broberg and Morrey score was 88.4,showing that 25 cases recovered excellently,15 well,and 5 so so,with a excellent rate of 55.5％ in group B.There were statistical differences between the two groups(P ＜ 0.05).Conclusions Internally fixing Mason type Ⅱ and Ⅲ radial head fractures with the double-head hollow compression screw is a practical method with the advantages of easy to operate,good reduction and implant position,earlier functional exercise,better elbow motion and function,fewer complications,and better patient satisfaction.