Unidad de Cirugía de Hombro y Codo, Servicio de Cirugía Ortopédica y Traumatología, Hospital General Universitario Gregorio Marañón, Madrid, Spain.
Unidad de Cirugía de Hombro y Codo, Servicio de Cirugía Ortopédica y Traumatología, Hospital General Universitario Gregorio Marañón, Madrid, Spain.
Injury. 2020 Apr;51 Suppl 1:S89-S93. doi: 10.1016/j.injury.2020.02.028. Epub 2020 Feb 10.
The management of radial head fractures for the treatment of complex elbow dislocations remains controversial. Until the publication of recent therapeutic algorithms, different actions have been carried out, including resection or arthroplasty of the radial head. This study aims to compare the clinical and radiological results of these two techniques.
A retrospective study was conducted between the years 2001 and 2016 in complex elbow dislocations associating comminuted fractures of the radial head (Mason type IV) for two cohorts: 20 patients who received a radial head prosthesis against 12 patients treated with resection. At the end of the follow-up, two functional valuation scales were applied: Mayo Elbow Performance Score (MEPS) and Disabilities of the Arm, Shoulder and Hand score (DASH). Radiological study included the presence of post-traumatic osteoarthritis and heterotopic ossifications in both groups; and specific complications in the group of patients treated with an arthroplasty.
The average age of the sample was 52.2 years in the prosthesis group, and 58.5 for the resection group, with a mean follow-up of 83.8 and 163 months respectively. No statistically significant differences were found in the mean values of the MEPS scale between the two groups (p = 0.5). The mean DASH score was significantly higher in the resection group (29.8 versus 10.3 with p = 0.006). A significantly higher rate of reinterventions and heterotopic ossifications was documented in the group of patients treated with radial head excision. The rate of specific radiological complications in the prosthesis group was 45%.
Although radial head resection could be a valid treatment in this group of patients, radial head arthroplasty would remain as the main option for the treatment of these lesions.
Level IV; Case Series; Treatment Study.
对于治疗复杂肘关节脱位的桡骨头骨折的处理方法仍然存在争议。直到最近治疗算法的发表，已经进行了不同的操作，包括桡骨头切除或关节成形术。本研究旨在比较这两种技术的临床和影像学结果。
回顾性研究于 2001 年至 2016 年在复杂肘关节脱位中进行，合并桡骨头粉碎性骨折（Mason 型 IV 型），分为两组：20 例患者接受桡骨头假体，12 例患者接受切除。在随访结束时，应用两种功能评估量表： Mayo 肘关节功能评分（MEPS）和上肢功能障碍评分（DASH）。放射学研究包括两组中创伤后骨关节炎和异位骨化的存在；以及接受关节成形术患者组的特定并发症。
假体组的平均年龄为 52.2 岁，切除组为 58.5 岁，平均随访时间分别为 83.8 和 163 个月。两组 MEPS 量表的平均值无统计学差异（p=0.5）。切除组 DASH 评分明显较高（29.8 比 10.3，p=0.006）。切除组的再干预和异位骨化发生率明显较高。假体组的特定放射学并发症发生率为 45%。
尽管桡骨头切除可能是这些患者的有效治疗方法，但桡骨头关节成形术仍将是治疗这些病变的主要选择。
IV 级；病例系列；治疗研究。
