| Objectives To investigate the effect of ORIF and prosthetic replacement for the treatment of radial head fractures of Mason type Ⅲ through a comprehensive comparison of the improvement of pain symptoms, the functional recovery of elbow joint and the complications after treatment, then providing reference for the clinical treatment choice of this kind of fracture.Methods Collecting the treated cases of radial head fractures of Mason type Ⅲ as the research objects from 2012 October to 2014 March in the traumatology department of the second hospital of Tangshan,and through the diagnostic criteria and uniform inclusion and exclusion criteria, 45 patients were included in research,according to the doctor’s advices and principle of voluntary patients choose operation method, and then carry out a prospective clinical study.Prostheic replacement group was experiment group, a total of 25 cases, open reduction and internal fixation group was control group, a total of 20 cases in which 13 cases fixed with micro plate system, 7 cases fixed with micro screw. All patients were followed up for at least 12 months, each case was followed up for at least 4 times. Observed the pain, extension and flexion of elbow, forearm rotation,imaging results and complications in different observation points and collected the data. Evaluated the function of elbow joint according to the Broberg and Morrey scoring system. Using SPSS17.0 statistical software processing all data and getting the objective results and conclusion through scientific analysis.Results 49 cases were included in the preliminary design, 1 case of internal fixation group and 2 cases of replacement group failed to follow up and to get a complete evaluation data, and 1 case of internal fixation group did the radial head prosthesis replacement after 3 months of ORIF. And both 2 cases of internal fixation was in miniplate group. All the 45 cases were followed up for an average of 15.21±2.02 months, obtained the complete data and entered the analysis of results. 1 All patients had no wound infection,radial nerve injury and no immunological after the screws,plates and prosthesis were implanted. 2 cases of internal fixation group appeared obvious traumatic arthritis. 2 cases appeared ectopic ossification after 1 year through X-ray examination. 5 patients had different degree of stiff elbow. Replacement group had no obvious traumatic arthritis and heterotopic ossification. The position of the prosthesis is nomal and the prosthesis had no loose, wear and deformation. 1 case felt mild pain when elbow weighted. Because of the prosthesis slightly longer, 1 case had mild joint stiffness. 2 One month after operation, the pain of replacement group was better than internal group(P<0.05). Before operation and in 3,6 and 12 month after operation, the relief of the pain had no significant difference(P>0.05). 3 In the 1st, 3rd, 6th and 12 th month after operation, the recovery and range of motion of flexion and extension and the pronation and supination of replacement groupwere better than internal fixation group(P<0.05). 4 In the 1st, 3rd, 6th and 12 th month after operation, the change of carrying angle which compared with the contralateral changed little in replacement group and had better recovery than internal fixation group(P<0.05). 5 In the 6th and 12 th month, the symptoms of injury limb and ability of daily activity of replacement group were better than internal fixation group(P<0.05). 6 In the 1st, 3rd, 6th and 12 th month after operation, Broberg-Morrey score of replacement group were higher than internal fixation group(P<0.01). At the last follow-up, the excellent and good rate of replacement group and internal fixation group was 96% and 70% respectively, the effect of the former recovered better than the latter(P<0.05). 7 During the 1st to 3rd month after operation, Broberg-Morrey score of screw fixation group were higher than mini-plate group(P<0.05), and the comparsion had no significant difference in 6th and 12 th month(P>0.05). The excellent and good rate between two groups had no statistical differences at the last follow-up(P>0.05).Conclusions In the treatment of comminuted radial head fractures of Mason type Ⅲ,prosthesis replacement has a better short-term effect than ORIF in aspects of the relief of pain, recovery of elbow function and reduction of complications. Replacement surgery is simple to operate. Prosthesis replacement can restore the stability of the elbow joint as far as possible, and obtain a better elbow function. ORIF could be considered for selection if internal fixation can reconstruct the anatomical structure of elbow and recover its stability. Both the screw fixation and mini-plate fixation have their own characteristics and advantages. The simple screw fixation can be applied if the fragment is large, otherwise the mini-plate system is the better choice. |
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