| Objectives Compare the clinical efficacy of two different internal fixation methods using Herbert screw and mini-plate in treating the Mason type Ⅱ radial head fractures.Methods Collect the clinical case data of 71 patients with the Mason type Ⅱ radial head fractures treated in the Dpartment of orthopedics Affiliated Hospital of North China University of Science and Technology(The second hospital of Tanshan) from October2008 to June 2014 by the medical record room. To select 63 cases through clear diagnostic criteria and strict inclusion and exclusion criteria. Collection and record the related cases,imaging data, operation data and postoperative follow-up records, and carry on a retrospective statistical analysis. Divide these cases into two groups according to the different internal fixation methods. 34 patients were treated with Herbert screw(A group),21 males and 13 females, aged from 18 to 65 years, with an average of 34.44±8.78 years old, on the left side of the 11 cases, 23 cases on the right side. The causes of injury: 25 cases of falls, 4 cases of traffic injury, 5 cases of falling injury, injury to operation time was 2~7 days, an average of 4.32±1.53 days. 29 patients were treated with mini-plate(B group), 18 males and 11 females, aged from 18 to 65 years, with an average of38.34±10.62 years old, on the left side of the 10 cases, 19 cases on the right side. The causes of injury: 19 cases of falls, 6 cases of traffic injury, 4 cases of falling injury, injury to operation time was 2~7 days, an average of 4.27±1.48 days. Comparative analysis of the two groups of the operation time, intraoperative blood loss, fracture healing time, different time periods of the visual analogue scale(VAS), Broberg and Morrey elbow score function and DASH score, the excellent and good rate of the function of elbow joint, elbow joint activity and postoperative complications.Results All the patients in the two groups were followed up for 12 to 24 months, with an average of 13.21±3.24 months. The incisions healed by first intention in the two groups.No blood vessel or nerve injury. No infection was found in the surgical incision. In operative time and intraoperative blood loss of group A is lower than group B, the difference between the two groups has statistical significance(P < 0.05). The difference of the two groups in the fracture healing time was not statistically significant(P > 0.05).Group A in 3 days, 1 weeks after the operation, 2 weeks after surgery, the pain relief was better than the group B, the difference between the two groups was statistically significant(P < 0.05). 4 weeks after surgery, the difference of pain score between the two groups has no statistical significance(P > 0.05). In postoperative 1 months, 3 months, the elbow function score of group A was higher than the group B, the difference between the two groups was highly statistically significant(P < 0.01). At 6 months and 12 months after operation, the difference of elbow joint function score between the two groups was not statistically significant(P > 0.05). At 12 months after operation, the superior rate of elbow joint function in group A(100%) was higher than that in group B(89.7%), and the difference between the two groups was not statistically significant(P > 0.05). At 12 months after surgery, the elbow motion of the group A was better than the group B, the difference between the two groups was statistically significant(P < 0.05). At 6 months and12 months after operation, the difference of the DASH score between the two groups was not statistically significant(P > 0.05). All the patients in the two groups had no postoperative infection, deep branch of radial nerve injury, nonunion, delayed union,malunion, elbow instability, radial head avascular necrosis and other complications. Norejection was found in the human body after screw and plate. The mini-plate internal fixation group did not see the bending and breaking of the plate, and the screw back.Review of X-ray at 1 month after surgery, 2 cases of mild heterotopic ossification(Hastings-Graham type type Ⅰ)were found in group A and 3 cases in group B. After 12 months follow-up, 2 cases of slight pain in elbow joint were found in group A and 2 cases in group B, when the elbow was active.Conclusions Herbert screw and mini plate are common internal fixation methods, used in the treatment of Mason type II radial head fractures. Compared with the mini plate,Herbert screw has shorter operation time, intraoperative bleeding, less fixed safe zone without limit, postoperative pain relief fast, elbow motion and early elbow function recovery, without second operation to remove, etc. Herbert screw can be used as the first choice for treatment of most of the Mason type II radial head fractures. |
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