關節鏡下撬撥復位內固定治療橈骨小頭骨折_《中國修復重建外科雜志》

作者：

王俊良 , 劉玉杰 , 李眾利 , 王志剛 , 魏民

解放軍總醫院骨科（北京，100853）;

關鍵詞：

關節鏡肘關節橈骨小頭骨折復位內固定

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【摘要】目的探討關節鏡下撬撥復位、經皮克氏針內固定治療橈骨小頭骨折的方法和臨床療效。方法回
顧分析2002 年8 月－ 2010 年5 月采用關節鏡下撬撥復位、經皮克氏針內固定治療的15 例橈骨小頭骨折患者臨床資料。
其中男11 例，女4 例；年齡17 ～ 41 歲，平均29.6 歲。左側6 例，右側9 例。致傷原因：摔傷8 例，交通事故傷4 例，運動
損傷3 例。受傷至入院時間為1 ～ 8 d，平均3.4 d。Mason Ⅱ型13 例，Ⅲ型2 例。合并外側副韌帶損傷5 例。術后肘關
節制動4 ～ 6 周，6 周后拔除克氏針行關節功能鍛煉。結果術后即刻X 線片檢查示骨折均達解剖復位。術后切口均
Ⅰ期愈合，無神經、血管損傷及針道感染，內固定物松動等并發癥發生。患者均獲隨訪，隨訪時間12 ～ 32 個月，平均25
個月；術后12 周骨折均達骨性愈合。末次隨訪時，肘關節屈伸活動度為（139.0 ± 7.9）°，與健側（141.0 ± 5.1）° 比較，差異無統計學意義（t=1.146，P=0.271）；旋前- 旋后活動度為（143.3 ± 7.0）°，與健側（146.0 ± 4.7）° 比較，差異無統計學意義（t=1.948，P=0.072）。肘關節功能根據Mayo 肘關節評分標準，為80 ～ 100 分，平均92 分；根據Broberg-Morrey 評分標準為85 ～ 100 分，平均95.2 分；獲優12 例，良3 例。結論關節鏡下撬撥復位、經皮克氏針內固定治療橈骨小頭MasonⅡ型及部分Ⅲ型骨折，復位準確、固定可靠、并發癥少，有利于關節功能恢復。

引用本文： 王俊良,劉玉杰,李眾利,王志剛,魏民. 關節鏡下撬撥復位內固定治療橈骨小頭骨折. 中國修復重建外科雜志, 2012, 26(2): 208-211. doi: 復制

1.	Dodson C, Nho S, Williams RJ 3rd, et al. Elbow arthroscopy. J Am Acad Orthop Surg, 2008, 16(10): 574-585.
2.	Haddad N, Chebil M, Mili W, et al. Technique and indications of elbow arthroscopy. A twelve-cases report. Tunis Med, 2009, 87(2): 120-122.
3.	Michels F, Pouliart N, Handelberg F. Arthroscopic management of Mason type 2 radial head fractures. Knee Surg Sports Traumatol Arthrosc, 2007, 15(10): 1244-1250.
4.	Rolla PR, Surace MF, Bini A, et al. Arthroscopic treatment of fractures of the radial head. Arthroscopy, 2006, 22(2): 233. e1-233. e6.
5.	Atesok K, Doral MN, Whipple T, et al. Arthroscopy-assisted fracture fixation. Knee Surg Sports Traumatol Arthrosc, 2011, 19(2): 320-329.
6.	劉碧峰, 林志金, 曹烈虎, 等. 切開復位內固定與橈骨小頭假體置換治療Mason Ⅲ型橈骨小頭骨折療效比較. 中國修復重建外科雜志, 2010, 24(8): 900-903.
7.	Ikeda M, K Sugiyama, Kang C, et al. Comminuted fractures of the radial head. Comparison of resection and internal fixation. J Bone Joint Surg (Am), 2005, 87(1): 76-84.
8.	王道喜, 唐學陽, 蔣欣, 等. 小兒MasonⅡ型橈骨頭頸部骨折的修復. 中國修復重建外科雜志, 2010, 24(4): 435-437.
9.	Ertürer E, Seçkin F, Akman S, et al. The results of open reduction and screw or K-wire fixation for isolated type II radial head fractures. Acta Orthop Traumatol Turc, 2010, 44(1): 20-26.
10.	Burkhart KJ, Nowak TE, Appelmann P, et al. Screw fixation of radial head fractures: compression screw versus lag screw—a biomechanical comparison. Injury, 2010, 41(10): 1015-1019.
11.	Ozkan Y, Oztürk A, Ozdemir RM, et al. Open reduction and internal fixation of radial head fractures. Ulus Travma Acil Cerrahi Derg, 2009, 15(3): 249-255.
12.	張英澤, 郭明珂, 鄭占樂, 等. 橈骨頭頸骨折治療方法的選擇與療效觀察. 中華外科雜志, 2009, 47(12): 896-898.
13.	Nalbantoglu U, Kocaoglu B, Gereli A, et al. Open reduction and internal fixation of Mason type III radial head fractures with and without an associated elbow dislocation. J Hand Surg(Am), 2007, 32(10): 1560-1568.
14.	Businger A, Ruedi TP, Sommer C. On-table reconstruction of comminuted fractures of the radial head. Injury, 2010, 41(6): 583-588.
15.	Müller MC, Burger C, Wirtz DC, et al. Replacement of the comminuted radial head fracture by a bipolar radial head prosthesis. Oper Orthop Traumatol, 2011, 23(1): 37-45.
16.	Chebil M, Kanoun ML, Ben Maitigue M, et al. Fracture of the radial head: the role of excision. Tunis Med, 2007, 85(2): 116-120.
17.	Kaas L, Turkenburg JL, van Riet RP, et al. Magnetic resonance imaging findings in 46 elbows with a radial head fracture. Acta Orthop, 2010, 81(3): 373-376.
18.	Kaas L, van Riet RP, Vroemen JP, et al. The incidence of associated fractures of the upper limb in fractures of the radial head. Strategies Trauma Limb Reconstr, 2008, 3(2): 71-74.
19.	Itamura J, Roidis N, Mirzayan R, et al. Radial head fractures: MRI evaluation of associated injuries. J Shoulder Elbow Surg, 2005, 14(4): 421-424.

1. Dodson C, Nho S, Williams RJ 3rd, et al. Elbow arthroscopy. J Am Acad Orthop Surg, 2008, 16(10): 574-585.
2. Haddad N, Chebil M, Mili W, et al. Technique and indications of elbow arthroscopy. A twelve-cases report. Tunis Med, 2009, 87(2): 120-122.
3. Michels F, Pouliart N, Handelberg F. Arthroscopic management of Mason type 2 radial head fractures. Knee Surg Sports Traumatol Arthrosc, 2007, 15(10): 1244-1250.
4. Rolla PR, Surace MF, Bini A, et al. Arthroscopic treatment of fractures of the radial head. Arthroscopy, 2006, 22(2): 233. e1-233. e6.
5. Atesok K, Doral MN, Whipple T, et al. Arthroscopy-assisted fracture fixation. Knee Surg Sports Traumatol Arthrosc, 2011, 19(2): 320-329.
6. 劉碧峰, 林志金, 曹烈虎, 等. 切開復位內固定與橈骨小頭假體置換治療Mason Ⅲ型橈骨小頭骨折療效比較. 中國修復重建外科雜志, 2010, 24(8): 900-903.
7. Ikeda M, K Sugiyama, Kang C, et al. Comminuted fractures of the radial head. Comparison of resection and internal fixation. J Bone Joint Surg (Am), 2005, 87(1): 76-84.
8. 王道喜, 唐學陽, 蔣欣, 等. 小兒MasonⅡ型橈骨頭頸部骨折的修復. 中國修復重建外科雜志, 2010, 24(4): 435-437.
9. Ertürer E, Seçkin F, Akman S, et al. The results of open reduction and screw or K-wire fixation for isolated type II radial head fractures. Acta Orthop Traumatol Turc, 2010, 44(1): 20-26.
10. Burkhart KJ, Nowak TE, Appelmann P, et al. Screw fixation of radial head fractures: compression screw versus lag screw—a biomechanical comparison. Injury, 2010, 41(10): 1015-1019.
11. Ozkan Y, Oztürk A, Ozdemir RM, et al. Open reduction and internal fixation of radial head fractures. Ulus Travma Acil Cerrahi Derg, 2009, 15(3): 249-255.
12. 張英澤, 郭明珂, 鄭占樂, 等. 橈骨頭頸骨折治療方法的選擇與療效觀察. 中華外科雜志, 2009, 47(12): 896-898.
13. Nalbantoglu U, Kocaoglu B, Gereli A, et al. Open reduction and internal fixation of Mason type III radial head fractures with and without an associated elbow dislocation. J Hand Surg(Am), 2007, 32(10): 1560-1568.
14. Businger A, Ruedi TP, Sommer C. On-table reconstruction of comminuted fractures of the radial head. Injury, 2010, 41(6): 583-588.
15. Müller MC, Burger C, Wirtz DC, et al. Replacement of the comminuted radial head fracture by a bipolar radial head prosthesis. Oper Orthop Traumatol, 2011, 23(1): 37-45.
16. Chebil M, Kanoun ML, Ben Maitigue M, et al. Fracture of the radial head: the role of excision. Tunis Med, 2007, 85(2): 116-120.
17. Kaas L, Turkenburg JL, van Riet RP, et al. Magnetic resonance imaging findings in 46 elbows with a radial head fracture. Acta Orthop, 2010, 81(3): 373-376.
18. Kaas L, van Riet RP, Vroemen JP, et al. The incidence of associated fractures of the upper limb in fractures of the radial head. Strategies Trauma Limb Reconstr, 2008, 3(2): 71-74.
19. Itamura J, Roidis N, Mirzayan R, et al. Radial head fractures: MRI evaluation of associated injuries. J Shoulder Elbow Surg, 2005, 14(4): 421-424.

《中國修復重建外科雜志》

關節鏡下撬撥復位內固定治療橈骨小頭骨折

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《中國修復重建外科雜志》

關節鏡下撬撥復位內固定治療橈骨小頭骨折

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