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中华肩肘外科电子杂志

中华肩肘外科电子杂志 ›› 2022, Vol. 10 ›› Issue (04) : 319 -326. doi: 10.3877/cma.j.issn.2095-5790.2022.04.006

论著

关节镜下与切开复位内固定治疗桡骨头骨折疗效比较的初步报道
王龑懋1, 何涛2, 陆晟迪1, 丁坚1,†()   
  1. 1. 200233　上海交通大学医学院附属第六人民医院骨科
    2. 610061　成都骨科医院骨科
  • 收稿日期:2022-09-12 出版日期:2022-11-05
  • 通信作者: 丁坚
  • 基金资助:
    国家自然科学基金(82203903); 上海交通大学医工交叉研究基金(YG2022QN088); 上海市第六人民医院基础科研项目(YNQN202103)

Comparison of arthroscopic and open reduction with internal fixation in the treatment of radial head fractures: a preliminary report

Yanmao Wang1, Tao He2, Shengdi Lu1, Jian Ding1,†()   

  1. 1. Department of Orthopedics, Shanghai Sixth People's Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai 200233, China
    2. Department of Orthopedics, Chengdu Orthopedic Hosiptal, Chengdu 610061, China
  • Received:2022-09-12 Published:2022-11-05
  • Corresponding author: Jian Ding
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引用本文：

王龑懋, 何涛, 陆晟迪, 丁坚. 关节镜下与切开复位内固定治疗桡骨头骨折疗效比较的初步报道[J]. 中华肩肘外科电子杂志, 2022, 10(04): 319-326.

Yanmao Wang, Tao He, Shengdi Lu, Jian Ding. Comparison of arthroscopic and open reduction with internal fixation in the treatment of radial head fractures: a preliminary report[J]. Chinese Journal of Shoulder and Elbow(Electronic Edition), 2022, 10(04): 319-326.

目的

探讨关节镜与开放切开复位内固定对于桡骨头骨折的治疗效果比较。

方法

回顾性分析2020年1月至2022年1月在本院行桡骨头骨折关节镜下或切开复位内固定的18~65岁Mason Ⅱ型及Ⅲ型的桡骨头骨折的病例，记录患者的年龄、性别、Mason分型、手术时间、透视次数、随访时间，以及术后功能结果[包括视觉模拟评分（visual analogue scale, VAS）、肘关节活动度以及Mayo肘关节功能评分系统（Mayo elbow performance score, MEPS）] 。

结果

共计34例患者纳入统计，其中关节镜组11例、切开复位内固定组23例。关节镜组患者手术时间明显多于切开复位内固定组，在短期内的疼痛（VAS评分）、活动度以及MEPS评分要明显好于切开复位内固定组，两组患者在远期疼痛及功能评分无显著性差异。

结论

关节镜与开放术式治疗桡骨头骨折均可取得良好疗效，关节镜在桡骨头骨折的治疗上具有创伤小、伤口美观、康复速度更快等优势。

关键词: 桡骨头骨折, 肘关节镜, 切开复位内固定, MEPS评分
Background

Radial head fractures are pretty common in clinics. Arthroscopic treatment of elbow joint trauma and complications has been widely used in clinical applications. Due to the occlusion of the annular ligament, the limitation of nail placement angle, and the risk of radial nerve injury, arthroscopic treatment of fracture of the radial head has not been widely carried out. There are few studies on comparison between arthroscopic and open reduction internal fixation for fracture of the radial head, especially for MasonⅢfracture of the radial head treated by arthroscopy.

Objective

To compare the effect of arthroscopy and open reduction internal fixation in treating radial head fractures.

Methods

A retrospective analysis was performed on cases of Mason type II and type III radial head fractures aged from 18 to 65 with arthroscopic or open reduction internal fixation of radial head fractures in one trauma center from January 2020 to January 2022. The patients' age, gender, Mason classification, operation time, fluoroscopy times, follow-up time, and postoperative functional outcomes (including pain, range of motion, and MEPS score) were recorded.

Results

A total of 34 patients were included in the study, including 11 patients in the arthroscopy group and 23 in the open reduction internal fixation group. The operation time of patients in the arthroscopy group was significantly longer than that in the open reduction group, and the pain (VAS score) , range of motion, and Mayo elbow performance score (MEPS) score were significantly better than those in the open reduction group in the short-term survey. The two groups did not differ between the long-term VAS score and functional score.

Conclusion

Arthroscopy and open surgery can achieve good results in treating radial head fractures. Besides, arthroscopy has the advantages of less trauma, smaller incision, and faster rehabilitation in treating radial head fractures.

Key words: Radial head fracture, Elbow arthroscopy, Open reduction and internal fixation, MEPS score
表1 两组患者一般资料及术中指标比较
组别 例数 性别 年龄（岁，±s） Mason分型 随访时间（周，±s） 手术时间（min，±s） 术中透视次数（次，±s）
男 女 II型 III型
EAIF组 11 7 4 38.4±9.3 9 2 19.8±5.3 61.2±8.2 1.2±0.4
ORIF组 23 11 12 32.2±5.0 15 8 16.3±4.4 49.0±9.8 1.4±0.5
t值或x2值   0.747 2.071 0.988 1.939 3.800 -1.307
P值   0.388 0.058 0.320 0.069 <0.001 0.204
表2 两组患者疼痛指标比较（±s）
组别 例数 VAS评分（分） 前臂旋转（°） 肘关节屈伸（°） MEPS评分（分）
术后2 d 术后2周 术后6周 终末随访 术后6周 终末随访 术后6周 终末随访 术后6周 终末随访
EAIF组 11 5.4±0.8 4.6±1.2 3.6±0.8 0.3±0.5 135.3±9.1 149.7±6.2 126.1±5.3 137.0±4.8 84.6±3.1 96.1±2.7
ORIF组 23 6.7±1.2 5.9±1.2 4.1±0.9 0.5±0.7 108.7±13.0 144.5±12.5 117.3±6.6 134.8±3.7 76.7±5.0 93.6±4.5
t值   -3.776 -2.781 -1.464 -1.260 6.882 1.624 4.159 1.318 5.581 2.036
P值   <0.001 0.012 0.157 0.219 <0.001 0.114 <0.001 0.206 <0.001 0.051
图1 伤后肘关节正侧位X线片（图A、B）及肘关节CT冠状位（图C）、矢状位（图D）
图2 患者行关节镜下桡骨头复位内固定术，术后第1天（图A、B）、第6周肘关节正侧位X线片（图C、D）
图3 患者术后功能照片，术后2周前臂旋转（图A、B）及肘关节屈伸（图C、D）功能，及术后6个月前臂旋转（图E、F）及肘关节屈伸（图G、H）功能
图4 典型病例2：男，45岁，桡骨头骨折（Mason Ⅲ型），伤后肘关节正侧位X片（图A、B）及肘关节CT冠状位（图C）、矢状位（图D）平扫
图5 患者行关节镜下桡骨头复位内固定术，术中镜下观察桡骨头粉碎性骨折（图A），粉碎为4块骨折块，关节面塌陷并翻转（图B），关节镜下予以复位（图C），置入空心钉固定（图D）
图6 术后第1天（图A、B）、第6周（图C、D）肘关节正侧位X线片
图7 患者术后功能照片，术后2周前臂旋转（图A、B）及肘关节屈伸（图C、D）功能，以及术后6月前臂旋转（图E、F）及肘关节屈伸（图G、H）功能
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