CAJ | 학술논문

目的探讨桡骨头骨折合并肱骨小头软骨损伤的发生率及损伤特点.方法对47例桡骨头骨折的患者行切开复位内固定术,术中发现其中9例合并肱骨小头软骨损伤.对于肱骨小头软骨损伤,若为表层软骨剥脱,则直接清除;若为关节面全层剥脱但面积太小难以固定,则清除骨片后用直径2.0mm克氏针在裸露骨面钻孔;若骨片较大或含部分软骨下骨,则复位后采用带线锚钉固定,即用克氏针经肱骨外髁外侧向软骨缺损区边缘钻孔,再插入7号注射针头,由关节面导入4-0编织缝线,收紧缝线并打结,将软骨片捆扎固定.结果术后所有患者均获得随访,时间为6～60个月,平均24.7个月.患者术后肘关节屈伸活动度为90°～130°,平均114°;前臂旋转活动度为130° ～160,平均148°.根据Broberg-Morrey标准评定肘关节功能:优5例,良3例,可1例.结论桡骨头骨折常常伴有肱骨小头软骨损伤的发生,临床医生应提高警觉,术前考虑到肱骨小头软骨损伤的可能性,做好周全准备.
목적 탐토뇨골두골절합병굉골소두연골손상적발생솔급손상특점.방법 대47례뇨골두골절적환자행절개복위내고정술,술중발현기중9례합병굉골소두연골손상.대우굉골소두연골손상,약위표층연골박탈,칙직접청제;약위관절면전층박탈단면적태소난이고정,칙청제골편후용직경2.0mm극씨침재라로골면찬공;약골편교대혹함부분연골하골,칙복위후채용대선묘정고정,즉용극씨침경굉골외과외측향연골결손구변연찬공,재삽입7호주사침두,유관절면도입4-0편직봉선,수긴봉선병타결,장연골편곤찰고정.결과 술후소유환자균획득수방,시간위6～60개월,평균24.7개월.환자술후주관절굴신활동도위90°～130°,평균114°;전비선전활동도위130° ～160,평균148°.근거Broberg-Morrey표준평정주관절공능:우5례,량3례,가1례.결론 뇨골두골절상상반유굉골소두연골손상적발생,림상의생응제고경각,술전고필도굉골소두연골손상적가능성,주호주전준비.
Objective To investigate the incidence and characteristics of capitellum cartilage injuries associated with radial head fractures.Methods Forty-seven patients with unstable,displaced Mason type Ⅱ to Ⅳ radial head fractures were treated with open retuction internal fixation.Nine of them had capitellum cartilage injuries concomitant with these fractures.Debridement of the fragments was performed for partial-thickness capitellum cartilage injuries.If the cartilage fragments were full-thickness but too small to fix,they were excised.The defective area was drilled with a 2.0 mm K-wire.If the fragment was relatively large,even with some subchondral bone,it was fixed with suture anchor after open reduction.Kirschner wire was used to drill a hole from the lateral condyle of the humerus towards the cartilage defect site.A 7-gauge needle was inserted to guide the 4-0 suture which was tied over the fragment to fasten it to the capitellum.Results The patients were follow-up for 6 to 60 months (mean 24.7 months).Postoperative elbow flexion extension range was 90° to 130°,with an average of 114°.Forearm pronation and supination range was 130° to 160°,with an average of 148°.According to Broberg-Morrey evaluation criteria,the results were excellent in 5 patients,good in 3 and fair in 1.Conclusion Capitellum cartilage injuries frequently occurred concomitantly with radial head fractures.The surgeon should be alert and prepared for treatment of the associated cartilage injuries.