桡骨头骨折：手术治疗还是保守治疗？希腊神庙模型。

Hammacher E R, van der Werken C

Dept. of Surgery, University Hospital Utrecht, The Netherlands.

Acta Orthop Belg. 1996;62 Suppl 1:112-5.

An important point in any communication on fracture treatment is agreement on classification of the fracture to be discussed. for fractures of the radial head there are several useful classification systems. The well-recognized Mason classification is particularly useful in the treatment of radial head fractures. It is however important to realize that the usefulness of this classification system is limited to radial head fractures without associated injury. In deciding on operative or conservative treatment it is therefore essential to subdivide fractures of the radial head into simple or complex fractures. As stated, the Mason classification system is most useful in deciding on treatment of simple fractures, that is to say fractures without an additional fracture or ligamentous injury. Type I fractures should be treated conservatively because of their excellent prognosis. The treatment of type II fractures is still controversial. The decision for osteosynthesis is not only based on the fracture configuration but certainly also on the talent of the surgeon involved. Immediate resection is not considered acceptable in this type of fracture. In type III fractures however, immediate excision is an acceptable method of treatment as long as there is no associated fracture or ligamentous injury. In deciding whether or not there is a complex injury the "Greek Temple" model is very useful. In this model the ulna and radius are seen as two "pillars" which support the "roof" of the distal humerus. The connection between the roof and the pillar on the ulnar side is formed by a ligament, on the radial side there is only the tension of the muscles. With this model it is easy to memorize which associated injuries form the basis of a complex injury, in which excision of the radial head or conservative treatment can cause ulnohumeral subluxation or late radioulnar instability. Treatment in these complex injuries should therefore in principle consist of reconstruction or temporary fixation of the radial pillar, and if necessary temporary stabilization of the ulnar pillar.

在任何关于骨折治疗的交流中，一个重要的要点是就所讨论骨折的分类达成共识。对于桡骨头骨折，有几种实用的分类系统。广为人知的梅森分类在桡骨头骨折的治疗中特别有用。然而，必须认识到，这种分类系统的实用性仅限于无相关损伤的桡骨头骨折。因此，在决定手术或保守治疗时，将桡骨头骨折细分为简单骨折或复杂骨折至关重要。如前所述，梅森分类系统在决定简单骨折的治疗方面最有用，也就是说没有额外骨折或韧带损伤的骨折。I型骨折因其预后良好应采用保守治疗。II型骨折的治疗仍存在争议。决定进行骨合成不仅基于骨折形态，当然也取决于相关外科医生的技术水平。对于这类骨折，立即切除是不可接受的。然而，在III型骨折中，只要没有相关骨折或韧带损伤，立即切除是一种可接受的治疗方法。在判断是否存在复杂损伤时，“希腊神庙”模型非常有用。在这个模型中，尺骨和桡骨被视为支撑肱骨远端“屋顶”的两根“柱子”。屋顶与尺侧柱子之间的连接由韧带形成，桡侧仅靠肌肉张力。通过这个模型，很容易记住哪些相关损伤构成了复杂损伤的基础，在这种情况下，切除桡骨头或保守治疗可能导致尺肱关节半脱位或晚期桡尺关节不稳定。因此，这些复杂损伤的治疗原则上应包括重建或临时固定桡侧支柱，必要时临时稳定尺侧支柱。