Shoulder and Elbow Unit, Hospital Universitario La Paz, Paseo de la Castellana 261, 28046 Madrid, Spain.
J Bone Joint Surg Am. 2010 Mar;92(3):558-66. doi: 10.2106/JBJS.I.00332.
In the past, radial head resection was the surgical treatment of choice for radial head fractures that could not be internally fixed. More recently, radial head implant arthroplasty has gained popularity for the treatment of isolated radial head fractures. The purpose of the present study was to review the long-term results of radial head resection after radial head fractures not associated with elbow instability in patients younger than forty years of age.
Twenty-six patients younger than forty years of age who had sustained an isolated fracture of the radial head (including six patients who had sustained a Mason type-II fracture and twenty who had sustained a Mason type-III fracture) that had been treated with primary radial head resection were reviewed retrospectively at a minimum of fifteen years (mean, twenty-five years). Outcomes were evaluated according to the Mayo Elbow Performance Score and the Disabilities of the Arm, Shoulder and Hand score. Radiographic assessment of osteoarthritic changes and the carrying angle was also performed.
Twenty-one patients (81%) had no elbow pain, three had mild pain, and two had moderate pain. The mean arc of motion was from 9 degrees to 139 degrees of flexion. All but one patient had a functional arc of motion. The mean pronation was 84 degrees, and the mean supination was 85 degrees. Nineteen elbows had normal strength in comparison with the unaffected side. The mean Mayo Elbow Performance Score was 95 points; the score was classified as good or excellent for twenty-four elbows (92%) and as fair for two. The mean Disabilities of the Arm, Shoulder and Hand score was 6 points. Three patients complained of wrist pain, which was mild in two patients and moderate in one. In four patients, some degree of elbow instability could be detected on physical examination. The mean carrying angle of the involved elbow was significantly greater than that of the uninjured elbow (21 degrees compared with 10 degrees). Radiographic changes of arthritis were considered mild in seventeen elbows and moderate in nine. We could not detect significant differences in functional outcome on the basis of the degree of radiographic change.
Radial head resection in young patients with isolated fractures without instability yields long-term satisfactory results in >90% of cases. Osteoarthritic changes are uniformly present but typically are not associated with functional impairment.
在过去，对于无法内固定的桡骨颈骨折，桡骨颈切除术是首选的手术治疗方法。最近，桡骨颈植入物关节成形术已广泛用于治疗孤立的桡骨颈骨折。本研究的目的是回顾桡骨颈骨折后桡骨颈切除的长期结果，这些骨折与 40 岁以下患者的肘关节不稳定无关。
回顾性分析 26 例年龄小于 40 岁的患者，这些患者均因孤立性桡骨颈骨折（包括 6 例 Mason Ⅱ型骨折和 20 例 Mason Ⅲ型骨折）而接受了桡骨颈切除术。所有患者的随访时间均至少为 15 年（平均 25 年）。采用 Mayo 肘关节功能评分和上肢残疾评分评估预后。还进行了放射学评估骨关节炎变化和携带角。
21 例（81%）患者无肘痛，3 例轻度疼痛，2 例中度疼痛。平均活动度为 9 度至 139 度屈曲。除 1 例患者外，所有患者的功能活动度均正常。平均旋前 84 度，平均旋后 85 度。19 例肘部与健侧相比力量正常。平均 Mayo 肘关节功能评分 95 分；24 例（92%）评为优或良，2 例评为可。平均上肢残疾评分 6 分。3 例患者诉腕痛，2 例轻度，1 例中度。4 例患者体格检查时可发现一定程度的肘关节不稳定。受累侧的平均携带角明显大于健侧（21 度比 10 度）。17 例放射学关节炎改变轻度，9 例中度。根据放射学改变程度，我们无法检测到功能预后的显著差异。
对于无不稳定的年轻患者孤立性骨折，桡骨颈切除可获得 90%以上的长期满意结果。骨关节炎改变普遍存在，但通常不会导致功能受损。
