Puchwein Paul, Heidari Nima, Dorr Katrin, Struger Lukas, Pichler Wolfgang
Department of Traumatology, Medical University of Graz, Auenbruggerplatz 7a, A-8036 Graz, Austria.
Orthopedics. 2013 Jan;36(1):e51-7. doi: 10.3928/01477447-20121217-18.
Operative treatment of displaced and comminuted radial head fractures involves internal fixation with plates and screws in cases where reconstruction is possible and replacement with a radial head prosthesis when comminution renders the radial head unreconstructable. The purposes of this study were to evaluate the morphometry of the radial head using a modern technique and to compare the findings with several commercially available radial head prostheses. Computed tomography scans of 30 cadaveric elbows and 3-dimensional reconstructions were used to analyze the morphometry of the proximal radius. Results were compared with the manufacturer data of several radial head prostheses. Mean diameter of the radial head at the level of the fovea was 19±1.58 mm (range, 15.82-21.81 mm) in the anteroposterior plane and 18.62±1.78 mm (range, 15.48-22.21 mm) in the radioulnar plane. Mean diameter of the radial head at its widest part was 23.15±1.94 mm (range, 19.45-26.49 mm) in the anteroposterior plane and 22.44±1.73 mm (range, 19.64-25.44 mm) in the radioulnar plane. Mean diameter of the radial head at the level of the head-neck junction was 15.42±1.59 mm (range, 11.80-18.46 mm) in the anteroposterior plane and 14.75±1.39 mm (range, 12.32-17.31 mm) in the radioulnar plane. Statistically significant sex differences existed in the maximum diameter of the radial head, the diameter at the level of the head-neck junction, and the length of the radial head. Currently available radial head prostheses cover the range of sizes encountered. Products with a choice of head and stem sizes in any combination are preferable. In unstable elbow fractures, correct implant size is an important factor to avoid subluxation of the radial head (Mason type IV fractures) if collateral ligaments are sufficient.
对于移位和粉碎性桡骨头骨折的手术治疗，在骨折能够重建的情况下采用钢板螺钉内固定，而当粉碎使桡骨头无法重建时则使用桡骨头假体进行置换。本研究的目的是使用现代技术评估桡骨头的形态，并将结果与几种市售的桡骨头假体进行比较。对30个尸体肘部进行计算机断层扫描并进行三维重建，以分析桡骨近端的形态。将结果与几种桡骨头假体的制造商数据进行比较。在前后平面上，桡骨头在中央凹水平的平均直径为19±1.58mm（范围为15.82 - 21.81mm），在桡尺平面上为18.62±1.78mm（范围为15.48 - 22.21mm）。桡骨头最宽处的平均直径在前后平面上为23.15±1.94mm（范围为19.45 - 26.49mm），在桡尺平面上为22.44±1.73mm（范围为19.64 - 25.44mm）。桡骨头在头颈交界处水平的平均直径在前后平面上为15.42±1.59mm（范围为11.80 - 18.46mm），在桡尺平面上为14.75±1.39mm（范围为12.32 - 17.31mm）。桡骨头的最大直径、头颈交界处的直径以及桡骨头的长度在性别上存在统计学显著差异。目前可用的桡骨头假体涵盖了所遇到的尺寸范围。具有多种头部和柄部尺寸组合可供选择的产品更为可取。在不稳定的肘部骨折中，如果侧副韧带足够，正确的植入物尺寸是避免桡骨头半脱位（梅森IV型骨折）的重要因素。
