Lópiz Yaiza, González Ana, García-Fernández Carlos, García-Coiradas Javier, Marco Fernando
Shoulder and Elbow Unit, Department of Orthopaedic Surgery, Clínico San Carlos Hospital, Complutense University of Madrid, Madrid, Spain.
Shoulder and Elbow Unit, Department of Orthopaedic Surgery, Clínico San Carlos Hospital, Complutense University of Madrid, Madrid, Spain.
Injury. 2016 Sep;47 Suppl 3:S29-S34. doi: 10.1016/S0020-1383(16)30603-9.
At present, surgical treatment of comminuted radial head fractures without associated instability continues to be controversial. When anatomical reconstruction is not possible, radial head excision is performed. However, the appearance of long-term complications with this technique, along with the development of new radial head implants situates arthroplasty as a promising surgical alternative. The purpose of the present study was to compare the mid-term functional outcomes of both techniques.
A retrospective study was performed between 2002 and 2011 on 25 Mason type-III fractures, 11 patients treated with primary radial head resection and 14 who received treatment of the fracture with metal prosthesis. At the end of follow-up, patients were contacted and outcomes evaluated according to: Mayo Elbow Performance Score (MEPS), the Disabilities of the Arm, Shoulder and Hand score (DASH) and strength measurement. Radiographic assessment (proximal migration of the radius, osteoarthritic changes, and signs of prosthesis loosening) was also performed.
The average age of the sample was 53.7 years in the resection group, and 54.4 years in the replacement group, with a mean follow-up of 60.3 and 42 months respectively. According to the MEPS scale, there were 6 excellent cases, 3 good and 2 acceptable in the resection group, and 6 excellent cases, 3 good, 3 acceptable, and 2 poor in the prosthesis group. The mean DASH score were 13.5, and 24.8 for the resection and the replacement group respectively. We found one postoperative complication in the resection group (stiffness and valgus instability) and 6 in the replacement group: 3 of joint stiffness, 1 case of prosthesis breakage, and 2 neurological injuries.
Although this is a retrospective study, the high complication rate occurring after radial head replacement in comparison with radial head resection, as well as good functional results obtained with this last technique, leads us to recommend it for comminuted radial head fractures without associated instability.
目前，对于无相关不稳定的粉碎性桡骨头骨折的手术治疗仍存在争议。当无法进行解剖重建时，会实施桡骨头切除术。然而，该技术长期并发症的出现，以及新型桡骨头植入物的发展，使得关节成形术成为一种有前景的手术替代方案。本研究的目的是比较这两种技术的中期功能结果。
对2002年至2011年间的25例梅森III型骨折进行了一项回顾性研究，其中11例患者接受了初次桡骨头切除术，14例接受了金属假体治疗骨折。随访结束时，联系患者并根据以下指标评估结果：梅奥肘关节功能评分（MEPS）、上肢、肩部和手部功能障碍评分（DASH）以及力量测量。还进行了影像学评估（桡骨近端移位、骨关节炎变化和假体松动迹象）。
切除组样本的平均年龄为53.7岁，置换组为54.4岁，平均随访时间分别为60.3个月和42个月。根据MEPS量表，切除组有6例优、3例良和2例可接受，假体组有6例优、3例良、3例可接受和2例差。切除组和置换组的平均DASH评分分别为13.5和24.8。我们在切除组发现1例术后并发症（僵硬和外翻不稳定），在置换组发现6例：3例关节僵硬、1例假体断裂和2例神经损伤。
尽管这是一项回顾性研究，但与桡骨头切除术相比，桡骨头置换术后的高并发症发生率，以及最后这项技术所获得的良好功能结果，使我们建议将其用于无相关不稳定的粉碎性桡骨头骨折。
