CAJ | 학술논문

目的探讨Ⅰ期修复所有骨性和关节囊韧带结构治疗Mason-JohnstonⅣ型桡骨头骨折的临床疗效. 方法 2007年8月-2011年11月,对16例Ⅳ型桡骨头骨折采用切开复位螺钉或钢板内固定同时用缝合锚钉修复撕裂的关节囊韧带结构,其中男11例,女5例；平均年龄31.6岁(18 ～52岁).左侧7例,右侧9例；主力侧13例,非主力侧3例.受伤至手术平均时间为6.2d(2～11 d).部分关节面2～3骨折块9例,完全关节面2～4骨折块7例.部分关节面骨折用直径1.5 mm、2.0 mm AO微型螺钉固定,完全关节面骨折复位后以直径2.0 mm AO微型钢板塑形后螺钉固定.术后早期指导患者进行肘关节主动及辅助功能锻炼.末次随访时采用视觉模拟评分(visual analogue scale,VAS)及Broberg-Morrey肘关节功能评分进行功能评估. 结果术后平均随访时间22.6个月(12～ 38个月),切口均Ⅰ期愈合,无感染发生；骨折均获得骨性愈合,平均愈合时间4.8个月(3.3 ～6.2个月).本组共10例(其中部分关节面骨折4例,完全关节面骨折6例)在肱骨内外髁韧带附着处出现较小而无临床症状的骨化现象.部分关节面骨折组优2例,良6,可1例,优良率为89％；完全关节面骨折组优1例,良4,可2例,优良率为72％.总优良率为81％.部分关节面骨折组与完全关节面骨折组比较,屈伸活动度、旋转活动度、Broberg-Morrey评分和VAS评分结果差异有统计学意义(P＜0.05). 结论 Ⅰ期修复所有骨性和关节囊韧带结构治疗Mason-JohnstonⅣ型桡骨头骨折,使其获得三个平面的及时稳定性,有利于早期功能练习,从而减少肘关节术后僵硬、疼痛和异位骨化等并发症.
목적 탐토Ⅰ기수복소유골성화관절낭인대결구치료Mason-JohnstonⅣ형뇨골두골절적림상료효. 방법 2007년8월-2011년11월,대16례Ⅳ형뇨골두골절채용절개복위라정혹강판내고정동시용봉합묘정수복시렬적관절낭인대결구,기중남11례,녀5례；평균년령31.6세(18 ～52세).좌측7례,우측9례；주력측13례,비주력측3례.수상지수술평균시간위6.2d(2～11 d).부분관절면2～3골절괴9례,완전관절면2～4골절괴7례.부분관절면골절용직경1.5 mm、2.0 mm AO미형라정고정,완전관절면골절복위후이직경2.0 mm AO미형강판소형후라정고정.술후조기지도환자진행주관절주동급보조공능단련.말차수방시채용시각모의평분(visual analogue scale,VAS)급Broberg-Morrey주관절공능평분진행공능평고. 결과 술후평균수방시간22.6개월(12～ 38개월),절구균Ⅰ기유합,무감염발생；골절균획득골성유합,평균유합시간4.8개월(3.3 ～6.2개월).본조공10례(기중부분관절면골절4례,완전관절면골절6례)재굉골내외과인대부착처출현교소이무림상증상적골화현상.부분관절면골절조우2례,량6,가1례,우량솔위89％；완전관절면골절조우1례,량4,가2례,우량솔위72％.총우량솔위81％.부분관절면골절조여완전관절면골절조비교,굴신활동도、선전활동도、Broberg-Morrey평분화VAS평분결과차이유통계학의의(P＜0.05). 결론 Ⅰ기수복소유골성화관절낭인대결구치료Mason-JohnstonⅣ형뇨골두골절,사기획득삼개평면적급시은정성,유리우조기공능연습,종이감소주관절술후강경、동통화이위골화등병발증.
Objective To evaluate the clinical outcomes of primary repair of bony and ligamentous components in treatment of Mason-Johnston type Ⅳ radial head fractures.Methods From August 2007 to November 2011,16 cases of Mason-Johnston type Ⅳ radial head fractures were treated by open reduction and screw or plate fixation combined with simultaneous repair of ruptured capsular ligaments with suture anchors.There were 11 men and 5 women with a mean age of 31.6 years (range,18-52 years).Totally,left side was involved in seven cases and right side in nine； dominant side was involved in 13 cases and non-prominent side in three.Time from injury to operation averaged 6.2 days (range,2-11 days).Nine cases of partial articular fractures with 2 or 3 fragments were treated with 1.5 mm or 2.0 mm AO miniscrews and seven cases of complete articular fractures with 2-4 fragments were treated with 2.0 mm AO mini plastic plates and screws after reduction.Active and assisted functional exercise was instructed in the early period after surgery.Visual analogue scale (VAS) and Broberg-Morrey elbow performance were measured for function assessment at the latest follow-up.Results Follow-up averaged 22.6 months (range,12-38 months),which showed primary wound healing without infection.All fractures achieved bony union at an average of 4.8 months (range,3.3-6.2 months).Ten out of the 16 cases,four of partial articular fractures and six of complete articular fractures,had slight but asymptomatic ossification in the medial and lateral collateral ligament attachment.There were two excellent,six good and one fair results in partial articular fracture group,with excellent-good rate of 89％ as well as one excellent,four good and two fair results in complete articular fracture group,with excellent-good rate of 72％.Moreover,the total excellentgood rate reached 81％.Range of motion in extension,flexion and rotation,Broberg-Morrey score and VAS presented statistical differences between partial and complete articular fracture groups (P ＜ 0.05).Conclusion Primary management of bony and ligamentous components to treat Mason-Johnston type Ⅳ radial head fractures brings timely three-dimensional stability of the elbow joint,favors early functional exercise and further decreases incidence of postoperative complications,such as elbow stiffness,pain and heterotopic ossification.