Neumann M, Nyffeler R, Beck M
Department of Orthopaedic and Trauma Surgery, University of Bern, Inselspital, 3010 Bern, Switzerland.
J Bone Joint Surg Br. 2011 Feb;93(2):223-8. doi: 10.1302/0301-620X.93B2.24760.
Mason type III fractures of the radial head are treated by open reduction and internal fixation, resection or prosthetic joint replacement. When internal fixation is performed, fixation of the radial head to the shaft is difficult and implant-related complications are common. Furthermore, problems of devascularisation of the radial head can result from fixation of the plate to the radial neck. In a small retrospective study, the treatment of Mason type III fractures with fixation of the radial neck in 13 cases (group 2) was compared with 12 cases where no fixation was performed (group 1). The mean clinical and radiological follow-up was four years (1 to 9). The Broberg-Morrey index showed excellent results in both groups. Degenerative radiological changes were seen more frequently in group 2, and removal of the implant was necessary in seven of 13 cases. Post-operative evaluation of these two different techniques revealed similar ranges of movement and functional scores. We propose that anatomical reconstruction of the radial head without metalwork fixation to the neck is preferable, and the outcome is the same as that achieved with the conventional technique. In addition degenerative changes of the elbow joint may develop less frequently, and implant removal is not necessary.
桡骨头梅森III型骨折的治疗方法包括切开复位内固定、切除术或人工关节置换术。进行内固定时，将桡骨头固定至骨干很困难，且与植入物相关的并发症很常见。此外，钢板固定于桡骨颈可能导致桡骨头血运障碍问题。在一项小型回顾性研究中，对13例采用桡骨颈固定治疗梅森III型骨折的病例（第2组）与12例未进行固定的病例（第1组）进行了比较。临床和影像学平均随访时间为4年（1至9年）。两组的布罗伯格-莫里指数均显示出良好的结果。第2组中更频繁地出现退行性放射学改变，13例中有7例需要取出植入物。对这两种不同技术的术后评估显示，活动范围和功能评分相似。我们认为，不将金属制品固定于颈部而对桡骨头进行解剖重建更为可取，其结果与传统技术相同。此外，肘关节的退行性改变可能较少发生，且无需取出植入物。
