A comparative study of radial head replacement versus internal fixation with T-shape steel plate and Herbert screws for treatment of Mason-Johnston typeⅢ radial head fractures
ZHONG Liangyu;DU Lanxiang;WANG Zhixiang;LI Jiangqun;LIU Shengfei;WU Qiumin;Ganzhou Hospital of Traditional Chinese Medicine;
Objective: To compare the clinical curative effects and safety of radial head replacement versus internal fixation with T-shape steel plate and Herbert screws for treatment of Mason-Johnston typeⅢradial head fractures. Methods: Forty-six patients with Mason-Johnston typeⅢradial head fractures were randomly divided into 2 groups,23 cases in each group,and were treated with radial head replacement( group A) and internal fixation with T-shape steel plate and Herbert screws( group B) respectively. The patients consisted of21 males and 25 females and ranged in age from 18 to 63 years( Median = 46 yrs) and ranged in disease course from 3 to 7 days( Median =4 days). The fractures located in left side for 16 patients and right side for 30 patients,and belonged to closed fractures. The operative time,intraoperative blood loss and complication incidences were recorded and compared between the 2 groups,and the clinical effects were compared between the 2 groups at last follow-up. Results: All patients in the 2 groups were followed up for 11-13 months with a median of 12 months. The operative time was shorter and the intraoperative blood loss was less in group A compared to group B( 49. 48 +/-6. 17 vs58. 57 +/-12. 79 min,t =-3. 069,P = 0. 004; 50. 49 +/-9. 63 vs 64. 26 +/-12. 94 m L,t =-4. 096,P = 0. 000). Elbow joint stiffness was found in group A( 1 case) and group B( 3 cases),and the elbow joint function recovered after elbow arthrolysis. Failed internal fixation( 1) and fracture nonunion( 1) were found in group B and the patients got a good result after radial head replacements. There was no statistical difference in complication incidences between the 2 groups( P = 0. 189). The clinical effects were evaluated according to Mayo elbow performance scores at last follow-up,and the results showed that pain scores and motor scores were higher in group A compared to group B( 42. 39 +/-5. 81 vs 37. 17 +/-9. 98 points,t = 2. 166,P = 0. 037; 19. 78 +/-1. 04 vs 18. 48 +/-2. 79 points,t = 2. 098,P = 0. 045) and there was no statistical difference in stability scores,activity of daily living( ADL) scores and total scores between the 2 groups( 9. 57 +/-1. 44 vs 8. 69 +/-2. 24 points,t = 1. 563,P = 0. 126; 24. 13 +/-1. 94 vs 21. 96 +/-4. 94 points,t = 1. 965,P = 0. 059; 95. 87 +/-7. 33 vs88. 91 +/-16. 85 points,t = 1. 815,P = 0. 079). Fourteen patients obtained an excellent result,8 good and 1 poor in group A; while 8 patients obtained an excellent result,8 good,4 fair and 3 poor in group B. The group A surpassed the group B in the total clinical curative effects( Z =-2. 171,P = 0. 030). Conclusion: Radial head replacement and internal fixation with T-shape steel plate and Herbert screws are similar to each other in safety in treatment of Mason-Johnston typeⅢradial head fractures,however,the former has such advantages as shorter operative time,less intraoperative blood loss,less pain,better motor function and better clinical comprehensive effect,so it is worthy of popularizing in clinic.
【CateGory Index】： R687.3