Ashwood N, Bain Gregory I, Unni R
Modbury Public Hospital, 196 Melbourne Street, North Adelaide, South Australia 5006, Australia.
J Bone Joint Surg Am. 2004 Feb;86(2):274-80. doi: 10.2106/00004623-200402000-00009.
Radial head fractures often occur in association with other elbow fractures and soft-tissue injuries. Radial head replacement is indicated for irreparable radial head fractures associated with elbow instability. The purpose of this study was to analyze the results after treatment of such injuries with a titanium radial head prosthesis, repair of torn collateral ligaments, and early mobilization of the elbow.
Sixteen patients with sixteen Mason type-III radial head fractures and collateral ligament injury were treated with use of a titanium radial head prosthesis over a five-year period at the Royal Adelaide Hospital and Modbury Public Hospital in South Australia. The surgery was performed acutely in ten patients and was delayed an average of thirty-seven days (range, fifteen to seventy-nine days) in six. All patients were followed clinically and radiographically for a mean of 2.8 years (range, 1.2 to 4.3 years).
Eight patients had an excellent result; five, a good result; and three, a fair result, according to the Mayo Elbow Performance Score. The three fair results occurred in patients with delayed surgery. The mean flexion contracture was 15 degrees (range, 0 degrees to 42 degrees ), with an average loss of 10 degrees (range, 0 degrees to 25 degrees ) of full flexion compared with that of the contralateral elbow. Both pronation and supination decreased an average of 12 degrees (range, 0 degrees to 45 degrees ) compared with that of the contralateral forearm.
The results of treatment of Mason type-III radial head fractures with a monoblock titanium radial head prosthesis and soft-tissue reconstruction are satisfactory. Early mobilization of the elbow is important for the restoration of elbow range of motion and function.
桡骨头骨折常与其他肘部骨折及软组织损伤同时发生。对于伴有肘部不稳定的不可修复性桡骨头骨折，需行桡骨头置换术。本研究旨在分析采用钛制桡骨头假体治疗此类损伤、修复撕裂的侧副韧带并早期活动肘部后的结果。
在南澳大利亚的皇家阿德莱德医院和莫德伯里公立医院，对16例伴有侧副韧带损伤的梅森III型桡骨头骨折患者，于五年期间使用钛制桡骨头假体进行治疗。10例患者急诊手术，6例平均延迟37天（范围15至79天）手术。所有患者均接受临床及影像学随访，平均随访2.8年（范围1.2至4.3年）。
根据梅奥肘关节功能评分，8例结果为优；5例为良；3例为中。3例结果为中的患者均为延迟手术者。平均屈曲挛缩为15度（范围0至42度），与对侧肘部相比，平均完全屈曲丧失10度（范围0至25度）。与对侧前臂相比，旋前和旋后均平均减少12度（范围0至45度）。
采用一体式钛制桡骨头假体及软组织重建治疗梅森III型桡骨头骨折的结果令人满意。早期活动肘部对恢复肘关节活动范围及功能很重要。
