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[1]鐘良鈺,杜蘭翔,王志相,等.橈骨頭置換術(shù)與T形鋼板聯(lián)合Herbert螺釘內(nèi)固定術(shù) 治療Mason-JohnstonⅢ型橈骨頭骨折的對(duì)比研究[J].中醫(yī)正骨,2018,30(08):21-25.
　ZHONG Liangyu,DU Lanxiang,WANG Zhixiang,et al.A comparative study of radial head replacement versus internal fixation with T-shape steel plate and Herbert screws for treatment of Mason-Johnston typeⅢradial head fractures[J].The Journal of Traditional Chinese Orthopedics and Traumatology,2018,30(08):21-25.
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橈骨頭置換術(shù)與T形鋼板聯(lián)合Herbert螺釘內(nèi)固定術(shù) 治療Mason-JohnstonⅢ型橈骨頭骨折的對(duì)比研究()
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《中醫(yī)正骨》[ISSN:1001-6015/CN:41-1162/R]

卷:
第30卷
期數(shù):
2018年08期
頁碼:
21-25
欄目:
臨床研究
出版日期:
2018-08-20

文章信息/Info

Title:
A comparative study of radial head replacement versus internal fixation with T-shape steel plate and Herbert screws for treatment of Mason-Johnston typeⅢradial head fractures
作者:
鐘良鈺; 杜蘭翔; 王志相; 厲江群; 劉盛飛; 吳秋敏
江西省贛州市中醫(yī)院,江西 贛州 341000
Author(s):
ZHONG Liangyu; DU Lanxiang; WANG Zhixiang; LI Jiangqun; LIU Shengfei; WU Qiumin
Ganzhou Hospital of Traditional Chinese Medicine,Ganzhou 341000,Jiangxi,China
關(guān)鍵詞:
橈骨骨折;  肘關(guān)節(jié);  關(guān)節(jié)成形術(shù); 置換;  骨折固定術(shù); 內(nèi);  臨床試驗(yàn)
Keywords:
radius fractures;  elbow joint;  arthroplasty; replacement;  fracture fixation; internal;  clinical trial
摘要:
比較橈骨頭置換術(shù)與T形鋼板聯(lián)合Herbert螺釘內(nèi)固定術(shù)治療Mason-JohnstonⅢ型橈骨頭骨折的臨床療效及安全性。方法:將46例Mason-JohnstonⅢ型橈骨頭骨折患者隨機(jī)分為2組,采用橈骨頭置換術(shù)治療23例,采用T形鋼板聯(lián)合Herbert螺釘內(nèi)固定術(shù)治療23例。男21例,女25例。年齡18～63歲,中位數(shù)46歲。均為閉合性骨折,左側(cè)16例、右側(cè)30例。受傷至手術(shù)時(shí)間3～7 d,中位數(shù)4 d。比較2組患者的手術(shù)時(shí)間、術(shù)中出血量及并發(fā)癥發(fā)生率,并于末次隨訪時(shí)比較2組患者的臨床療效。結(jié)果:所有患者均獲隨訪,隨訪時(shí)間11～13個(gè)月,中位數(shù)12個(gè)月。橈骨頭置換組的手術(shù)時(shí)間短于鋼板聯(lián)合螺釘組,術(shù)中出血量少于鋼板聯(lián)合螺釘組[(49.48±6.17)min,(58.57±12.79)min,t=-3.069,P=0.004;(50.49±9.63)mL,(64.26±12.94)mL,t=-4.096,P=0.000]。橈骨頭置換組1例出現(xiàn)肘關(guān)節(jié)僵硬,采用肘關(guān)節(jié)松解術(shù)治療后關(guān)節(jié)功能恢復(fù)。鋼板聯(lián)合螺釘組3例出現(xiàn)肘關(guān)節(jié)僵硬,采用肘關(guān)節(jié)松解術(shù)治療后關(guān)節(jié)功能恢復(fù); 1例出現(xiàn)內(nèi)固定失效,1例出現(xiàn)骨折不愈合,采用橈骨頭置換術(shù)治療后效果滿意。2組患者的并發(fā)癥發(fā)生率比較,差異無統(tǒng)計(jì)學(xué)意義(P=0.189)。末次隨訪時(shí),按照Mayo肘關(guān)節(jié)功能評(píng)分標(biāo)準(zhǔn)評(píng)定療效,橈骨頭置換組的疼痛評(píng)分及運(yùn)動(dòng)評(píng)分高于鋼板聯(lián)合螺釘組[(42.39±5.81)分,(37.17±9.98)分,t=2.166,P=0.037;(19.78±1.04)分,(18.48±2.79)分,t=2.098,P=0.045]; 兩組的穩(wěn)定性評(píng)分、日常生活功能評(píng)分及總分比較,組間差異無統(tǒng)計(jì)學(xué)意義[(9.57±1.44)分,(8.69±2.24)分,t=1.563,P=0.126;(24.13±1.94)分,(21.96±4.94)分,t=1.965,P=0.059;(95.87±7.33)分,(88.91±16.85)分,t=1.815,P=0.079]。橈骨頭置換組優(yōu)14例、良8例、差1例,鋼板聯(lián)合螺釘組優(yōu)8例、良8例、可4例、差3例,橈骨頭置換組的臨床綜合療效優(yōu)于鋼板聯(lián)合螺釘組(Z=-2.171,P=0.030)。結(jié)論:橈骨頭置換術(shù)與T形鋼板聯(lián)合Herbert螺釘內(nèi)固定術(shù)治療Mason-JohnstonⅢ型橈骨頭骨折的安全性相當(dāng),但前者具有手術(shù)時(shí)間短、術(shù)中出血量少、疼痛程度輕、運(yùn)動(dòng)功能恢復(fù)良好、臨床綜合療效好的優(yōu)點(diǎn),值得臨床推廣應(yīng)用。
Abstract:
To compare the clinical curative effects and safety of radial head replacement versus internal fixation with T-shape steel plate and Herbert screws for treatment of Mason-Johnston typeⅢradial head fractures.Methods:Forty-six patients with Mason-Johnston typeⅢradial head fractures were randomly divided into 2 groups,23 cases in each group,and were treated with radial head replacement(group A)and internal fixation with T-shape steel plate and Herbert screws(group B)respectively.The patients consisted of 21 males and 25 females and ranged in age from 18 to 63 years(Median=46 yrs)and ranged in disease course from 3 to 7 days(Median=4 days).The fractures located in left side for 16 patients and right side for 30 patients,and belonged to closed fractures.The operative time,intraoperative blood loss and complication incidences were recorded and compared between the 2 groups,and the clinical effects were compared between the 2 groups at last follow-up.Results:All patients in the 2 groups were followed up for 11-13 months with a median of 12 months.The operative time was shorter and the intraoperative blood loss was less in group A compared to group B(49.48+/-6.17 vs 58.57+/-12.79 min,t=-3.069,P=0.004; 50.49+/-9.63 vs 64.26+/-12.94 mL,t=-4.096,P=0.000).Elbow joint stiffness was found in group A(1 case)and group B(3 cases),and the elbow joint function recovered after elbow arthrolysis.Failed internal fixation(1)and fracture nonunion(1)were found in group B and the patients got a good result after radial head replacements.There was no statistical difference in complication incidences between the 2 groups(P=0.189).The clinical effects were evaluated according to Mayo elbow performance scores at last follow-up,and the results showed that pain scores and motor scores were higher in group A compared to group B(42.39+/-5.81 vs 37.17+/-9.98 points,t=2.166,P=0.037; 19.78+/-1.04 vs 18.48+/-2.79 points,t=2.098,P=0.045)and there was no statistical difference in stability scores,activity of daily living(ADL)scores and total scores between the 2 groups(9.57+/-1.44 vs 8.69+/-2.24 points,t=1.563,P=0.126; 24.13+/-1.94 vs 21.96+/-4.94 points,t=1.965,P=0.059; 95.87+/-7.33 vs 88.91+/-16.85 points,t=1.815,P=0.079).Fourteen patients obtained an excellent result,8 good and 1 poor in group A; while 8 patients obtained an excellent result,8 good,4 fair and 3 poor in group B.The group A surpassed the group B in the total clinical curative effects(Z=-2.171,P=0.030).Conclusion:Radial head replacement and internal fixation with T-shape steel plate and Herbert screws are similar to each other in safety in treatment of Mason-Johnston typeⅢradial head fractures,however,the former has such advantages as shorter operative time,less intraoperative blood loss,less pain,better motor function and better clinical comprehensive effect,so it is worthy of popularizing in clinic.

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備注/Memo:
通訊作者:鐘良鈺 E-mail:[email protected]
更新日期/Last Update: 2018-08-31