目的 探讨肘关节镜下治疗Maison II型桡骨头骨折的疗效和安全性，评估其优劣及应用前景。 方法 回顾性分析肘关节镜下治疗Maison II型桡骨头骨折患者的临床资料，包括患者的年龄、性别、骨折类型、手术方式、手术时间、术后并发症等相关信息。所有患者均进行了随访，评估术后疗效和并发症。同时，综合分析近5年来国内、外文献，对肘关节镜下治疗桡骨头骨折的优劣进行探讨。 结果 共纳入42例患者，所有患者均采用肘关节镜下螺钉内固定。术后X线检查显示骨折均获得了满意的复位和愈合。随访时间为12~36个月，平均22.5个月。术后3个月和随访结束时，所有患者的肘关节功能得到了显著改善，VAS评分和DASH评分均显著降低。并发症包括2例肘关节功能受限，均经过康复治疗得到缓解。文献综述显示，肘关节镜下治疗Maison II型桡骨头骨折具有微创、减少软组织损伤、恢复快、术后并发症少等优点，但对于部分复杂性骨折和严重软组织损伤的患者，其疗效有限。 结论 肘关节镜下治疗桡骨头骨折是一种安全有效的治疗方法，可以获得满意的疗效和功能恢复。但需要注意手术操作技巧和患者术后康复的管理。此外，对于复杂性骨折和严重软组织损伤的患者，应进行合理的手术选择和术后管理。
Abstract
Objective To explore the efficacy and safety of elbow arthroscopy in the treatment of Maison II radial head fractures, and evaluate its advantages and disadvantages as well as its application prospects. Methods This study retrospectively analyzed the clinical data of patients with Maison II radial head fractures treated by elbow arthroscopy, including age, gender, fracture type, surgical method, operation time, postoperative complications, etc. All patients were followed up to evaluate the postoperative treatment effect and complications. At the same time, a comprehensive analysis of domestic and foreign literature in the past 5 years was conducted to discuss the advantages and disadvantages of elbow arthroscopy in the treatment of radial head fractures. Results A total of 42 patients were included, and all patients underwent screw internal fixation under elbow arthroscopy. Postoperative X-ray examination showed satisfactory reduction and healing of fractures. The follow-up period was 12-36 months, with an average of 22.5 months. At 3 months postoperatively and at the end of follow-up, the elbow joint function of all patients improved significantly, and the VAS score and DASH score were significantly reduced. Complications included 2 cases of limited elbow joint function, which were relieved after rehabilitation treatment. Literature review showed that elbow arthroscopy in the treatment of Maison II radial head fractures has the advantages of minimally invasive, reduced soft tissue damage, quick recovery, and fewer postoperative complications. However, for some complex fractures and severe soft tissue injuries, its efficacy is limited. Conclusions Elbow arthroscopy is a safe and effective treatment method for radial head fractures, which can achieve satisfactory therapeutic effects and functional recovery. However, attention should be paid to surgical techniques and postoperative rehabilitation management. In addition, for patients with complex fractures and severe soft tissue injuries, reasonable surgical selection and postoperative management should be carried out.
关键词
肘关节镜 /
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桡骨头骨折 /
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内固定 /
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治疗效果
Key words
Elbow arthroscopy /
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Radial head fracture /
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Internal fixation /
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Therapeutic effect
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参考文献
[1] Guerra E, Marinelli A, Tortorella F, et al. Elbow arthroscopy for the treatment of radial head fractures: surgical technique and 10 years of follow up results compared to open surgery[J]. J Clin Med, 2023, 12(4):1558. DOI:10.3390/jcm12041558.
[2] Burkhart KJ, Mattyasovszky SG, Runkel M, et al. Mid- to long-term results after bipolar radial head arthroplasty. [J] Shoulder Elbow Surg, 2010, 19(7):965-972. DOI: 10.1016/j.jse.2010.05.022.
[3] Kwak JM, Sun Y, Kholinne E, et al. Surgical outcomes for post-traumatic stiffness after elbow fracture: comparison between open and arthroscopic procedures for intra- and extra-articular elbow fractures[J]. J Shoulder Elbow Surg, 2019, 28(10):1998-2006. DOI:10.1016/j.jse.2019.06.008.
[4] Ibrahim MRK, Semaya AE, Hasan M, et al. Arthroscopic percutaneous fixation of Mason type 2 radial head fractures[J]. Orthop J Sports Med, 2024, 12(8):23259671241270351. DOI:10.1177/23259671241270351.
[5] Al-Tawil K, Arya A. Radial head fractures[J]. J Clin Orthop Trauma, 2021, 20:101497. DOI:10.1016/j.jcot.2021.101497.
[6] Burke CE, McKegg PC, Wong AL, et al. Association of radial head fracture treatment with long-term function[J]. Hand (NY), 2024, 19(1):30-37. DOI:10.1177/15589447221109631.
[7] Mousa H, Williams D, Aresti N. Arthroscopic reduction internal fixation for displaced radial head fractures: a systematic review of the outcomes and complications[J]. JSES Rev Rep Tech, 2024, 4(4):710-714. DOI:10.1016/j.xrrt.2024.08.001.
[8] Haasters F, Helfen T, Böcker W, et al. The value of elbow arthroscopy in diagnosing and treatment of radial head fractures[J]. BMC Musculoskelet Disord, 2019, 20(1):343. DOI:10.1186/s12891-019-2726-6.
[9] Lee CH, Woo S, Choi HD. Results of the use of bioabsorbable magnesium screws for surgical treatment of Mason type II radial head fractures[J]. Clin Orthop Surg, 2023, 15(6):1013-1021. DOI:10.4055/cios23074.
[10]Captier G, Canovas F, Mercier N, et al. Biometry of the radial head: biomechanical implications in pronation and supination[J]. Surg Radiol Anat, 2002, 24(5):295-301. DOI: 10.1007/s00276-002-0059-9.
[11]Shannon HL, Deluce SR, Lalone EA, et al. Effect of radial head implant shape on joint contact area and location during static loading [J]. J Hand Surg Am, 2015, 40(4):716-722. DOI:10.1016/j.jhsa.2014.12.017.
[12]Zhang C, Zhong B, Luo CF. Treatment strategy of terrible triad of the elbow: Experience in Shanghai 6th People's Hospital[J]. Injury, 2014, 45(6): 942–948. DOI: https://doi.org/10.1016/j.injury.2014.01.016.
[13]Ballesteros-Betancourt JR, Lázaro-Amorós A, García-Tarriño R, et al. Classification of the transverse pattern of Mason II radial head fractures and its usefulness in arthroscopic osteosynthesis. Anatomo-surgical study[J]. Rev Esp Cir Ortop Traumatol (Engl Ed), 2019, 63(1):12-19. DOI: 10.1016/j.recot.2018.07.003.
[14]Michels F, Pouliart N, Handelberg F. Arthroscopic management of Mason type 2 radial head fractures[J]. Knee Surg Sports Traumatol Arthrosc, 2007, 15(10):1244-1250. DOI:10.1007/s00167-007-0378-9.
[15]Rolla PR, Surace MF, Bini A, et al. Arthroscopic treatment of fractures of the radial head[J]. Arthroscopy, 2006, 22(2):233.e1-233.e6. DOI:10.1016/j.arthro.2005.10.003.
[16]Chemama B, Bonnevialle N, Peter O, et al. Terrible triad injury of the elbow: How to improve outcomes [J]? Orthop Traumatol Surg Res, 2010, 96(2): 147-154. DOI: 10.1016/j.otsr.2009.12.005.
[17]Fink Barnes LA, Parsons BO, Hausman M. Arthroscopic management of elbow fractures[J]. Hand Clin, 2015, 31(4):651-661. DOI:10.1016/j.hcl.2015.06.011.
[18]Gao X, Yin HL, Zhou GJ. Minimally invasive treatment of Mason type II radial head fracture by intramedullary pinning[J]. Orthop Surg, 2019,11(5):879-885. DOI:10.1111/os.12540.
[19]Park JW, Kim KT, Sung JK, et al. Biomechanical comparison of inter-fragmentary compression pressures: lag screw versus Herbert screw for anterior odontoid screw fixation. J Korean Neurosurg Soc, 2017, 60(5):498-503. DOI: 10.3340/jkns.2017.0202.011.
[20]Marti D, Spross C, Jost B. The first 100 elbow arthroscopies of one surgeon: analysis of complications[J]. J Shoulder Elbow Surg, 2013, 22(4):567-573. DOI:10.1016/j.jse.2012.12.001.
[21]El Hajj F, Hoteit M, Ouaknine M. Elbow arthroscopy: An alternative to anteromedial portals[J]. Orthop Traumatol Surg Res, 2015,101(4):411-414. DOI:10.1016/j.otsr.2015.03.011.
[22]Keyt LK, Jensen AR, O'Driscoll SW, et al. Establishing the learning curve for elbow arthroscopy: surgeon and trainee perspectives on number of cases needed and optimal methods for acquiring skill[J]. J Shoulder Elbow Surg, 2020, 29(11):e434-e442. DOI:10.1016/j.jse.2020.04.022.
[23]Batko BD, Hakakian D, Norin JL, et al. Complications in elbow arthroscopy: management and prevention[J]. Sports Med Arthrosc Rev, 2022, 30(1):54-62. DOI:10.1097/JSA.0000000000000334.
[24]Elfeddali R, Schreuder MH, Eygendaal D. Arthroscopic elbow surgery, is it safe [J]? J Shoulder Elbow Surg, 2013, 22(5):647-652. DOI: 10.1016/j.jse.2013.01.032.
基金
江苏省卫健委老年健康科研面上项目（LKM2022021）；苏州市运动医学重点学科（SZXK202104）
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