【摘要】 [目的]比较MasonⅢ型桡骨头骨折桌面拼接固定与假体置换的临床疗效。[方法]回顾性分析2005年1月～2017年1月手术治疗的27例MasonⅢ型桡骨头骨折患者的临床资料,其中,11例行桡骨头桌面拼接固定,16例行桡骨小头假体置换。比较两组围手术期、随访和影像资料。[结果]两组患者均顺利完成手术,均未发生血管、神经损伤和感染等严重并发症。固定组手术时间、术中失血量均优于置换组(P?0.05),两组切口长度、住院天数的差异无统计学意义(P?0.05)。所有患者平均随访(20.07±1.84)个月,置换组在开始主动活动时间、完全负重活动时间、末次随访时肘关节屈伸ROM、前臂旋转ROM和Morrey评分均显著优于固定组(P<0.05),而末次随访时两组间VAS评分的差异无统计学意义(P?0.05)。影像方面,固定组出现2例无症状性骨不连,1例螺钉断裂、1例螺钉滑出,在钢板螺钉取出后未予特殊处理。置换组均未发生假体松动等现象。[结论]对MasonⅢ型桡骨头骨折,假体置换的临床效果明显优于桌面拼接固定。更多还原

【Abstract】 [Objective] To compare the clinical outcomes of on-table reconstruction and fixation versus prosthetic replacement for irreducible Mason type Ⅲ radial head fractures. [Methods] From January 2005 to January 2017, 27 patients underwent surgical treatment for irreducible Mason type Ⅲ radial head fractures. Of them, 11 patients received on-table reconstruction and fixation, while the remaining 16 patients had prosthetic replacement of the radial head. The perioperative, follow-up and radiographic data were compared between the two groups. [Results] All patients in both groups received successful operations, without serious complications, such as neurovascular injuries and infection. The fixation group was significantly superior to the replacement group in operation time and intraoperative blood loss(P<0.05), nevertheless no statistical differences were found in incision length and hospital stay between them(P>0.05). All the patients in both groups were followed up for(20.07±1.84) months on an average. The replacement group proved significantly superior to the fixation group regarding to the time to recover active motion, the time to return full-weight bearing activity, flexion-extension and pronation-supernation range of motions(ROM) of the affected elbow at the latest follow-up, as well as Morrey score at the latest follow-up(P<0.05), despite of the fact that no a statistical difference in VAS score at the final interview was proved between them(P>0.05). In term of radiographic evaluation, asymptomatic nonunion was noted in 2 patients of the fixation group, associated with screw broken in 1 patient and screw out in another one, which was handled by removing the implants only. By contrast, no prosthetic loosening was noted in anyone of the replacement group. [Conclusion] The prosthetic replacement of radial head is considerably superior to the on-table reconstruction and fixation in term of clinical consequences for the irreducible Mason type Ⅲ radial head fractures,更多还原