微型钢板治疗MasonⅢ型桡骨头骨折疗效分析.docVIP

微型钢板治疗MasonⅢ型桡骨头骨折疗效分析 　 作者：蔡晓冰，纪方，曹磊，佟大可，王秋根，张秋林，汪滋民，唐昊，汪方 【摘要】 ［目的］对Mason Ⅲ型桡骨头骨折的治疗存在争议，一般主张保留桡骨头，但对于严重的粉碎性桡骨头骨折固定比较困难，本文主要是探讨采用切开复位微型钢板结合克氏针内固定手术分析其疗效。［方法］本组7例，男6例，女1例，均为Mason Ⅲ型骨折，其中2例累及桡骨颈，对7例Mason Ⅲ型桡骨头骨折病例采用切开复位微型钢板辅助克氏针内固定手术，必要时取自体骨进行植骨。［结果］随访14～39个月，平均20.3个月，所有桡骨头骨性愈合，无１例发生桡骨头缺血性坏死，1例肘关节运动受限，但X线片见骨性愈合。按照Brobrg 和Morrey的肘关节评分标准，肘关节的功能评分平均为87分，其中优2例，良4例，优良率85.7%。［结论］本组7例均为Mason Ⅲ型，作者认为通过微型钢板，结合克氏针，对有骨缺损和塌陷的桡骨头进行植骨，术后随访临床可获得较满意的肘关节灵活度，是手术保留Mason Ⅲ型骨折的桡骨头，减少桡骨头切除和假体置换的一种方法，但本组病例数较少，随访时间短，有待于进一步观察疗效。 【关键词】 桡骨头； Mason Ⅲ型骨折； 治疗 　　Effect and treatment of Mason typeⅢ radial head fractures with type-T plate 　　Abstract：［Objective］To analyze the result of mini-type T plate for treatment of Mason type-III radial head fracture.［Method］Seven cases of Mason typeⅢ radial head fractures, 6 male and 1 female, including 2 cases with radial neck fractures, were treated by open reduction and mini-type T plate fixation associated with Kirscher wires. If necessary, bone graft was placed between radial head and neck.［Result］The patients were followed up for an average of 20.3 months (ranged from 14 to 39 months). All fractured radial heads were heal and no case appeared ischemic necrosis. According to the Brobrg and Morrey functional elbow index, the averaged score was 87 points and the outcome was excellent in 2 patients, good in 4, the excellent and good rate was 85.7%.［Conclusion］Treatment of Mason typeⅢ radial head fractures by open reduction, mini type T plate fixation assocated with Kerscher’s wire and autogenous bone graft showed a high union rate of fracture and satisfactory joint function but no ischemic necrosis with the advantages of reservation of radial head and decreasing the rate of re-section and prosthesis replacement. Further observation should be taken to get more clinical cases number. 　　Key words：radial head; Mason type Ⅲ fracture; treatment 　　目前对Mason Ⅲ型桡骨头骨折的治疗存在争议。现一般主张保留桡骨头，但对于严重的粉碎性桡骨头骨折固定比较困难［1～3］。为探讨Mason Ⅲ型桡骨头骨折保留桡骨头的方法，回顾本院2003年3月～2006年2月采用切开复位