目的：探讨关节镜下桡骨小头切除术治疗桡骨小头陈旧性骨折的临床疗效。方法对13例桡骨小头陈旧性骨折患者在臂丛神经阻滞麻醉下行肘关节镜下桡骨小头切除术、关节腔清理、瘢痕滑膜切除及适当的关节囊松解等处理。术后给予镇痛配合下早期行功能康复锻炼。对13例患者术前、术后 Mayo肘关节功能评分、肘关节屈曲角度、肘关节伸直角度及肘关节屈伸活动范围进行比较。结果13例患者术后随访5～18个月，平均10．3个月。Mayo肘关节功能评分：术前50～75分，平均（65．38±6．91）分；术后70～90分，平均（78．85±7．12）分，术前、术后 Mayo肘关节功能评分值比较差异有统计学意义（z＝-3．072，P＝0．002）。肘关节屈曲角度：术前30°～80°，平均（56．54±12．84）°，术后90°～120°，平均（106．54±11．44）°，较术前改善50°；肘关节伸直角度：术前-70°～0°，平均（-21．92±27．12）°，术后-15°～0°，平均（-3．85±5．06）°，较术前改善18．07°；肘关节屈伸范围：术前0°～60°，平均（34．62±21．23）°，术后80°～120°，平均（102．69±10．73）°，术前、术后肘关节屈伸范围值比较差异有统计学意义（z＝-3．189，P＝0．001）。无一例出现神经、血管损伤，关节感染和异位骨化等并发症。结论关节镜下桡骨小头切除术具有创伤小、出血少、术后恢复快及并发症少等优点，对于桡骨小头陈旧性骨折伴肘关节功能障碍的患者，是一种安全、有效、可行的微创治疗方式。%Objective To investigate the clinical efficacy of arthroscopic radial head excision for old radial head fractures.Methods Thirteen patients with old radial head fractures were treated with arthroscopic radial head excision,joint cavity debridement,synovectomy and proper joint capsule release under brachial plexus anesthesia.Postoperative analgesia and early functional re-habilitation exercise were performed in all patients.Mayo elbow performance score,elbow flexion angle,elbow extension angle and elbow motion range were determined before and after operation. Results Patients were followed up for an average of 10.3 months(range,5 to 18 months).Mayo elbow performance score significantly increased from preoperative 65.38±6.91(range,50 to 75) to postoperative 78.85±7.12(range,70 to 90)(z=-3.072,P=0.002).Elbow flexion angle was improved from preoperative(56.54 ± 12.84)°(range,30° to 80°)to postoperative(106.54 ± 11.44)°(range,90°to 120°).Elbow extension angle was improved from preoperative(-21.92± 27.12)°(range,-70°to 0°)to postoperative(-3.85±5.06)°(range,-15°to 0°).Elbow motion range significantly increased from preoperative(34.62±21.23)°(range,0°to 60°)to postoperative (102.69±10.73)°(range,80°to 120°)(z=-3.189,P=0.001).No patients had nerve injury, blood vessel damage,j oint infection,ectopic ossification and other complications.Conclusion Ar-throscopic radial head resection is associated with smaller incision,less bleeding,faster recovery and fewer complications,and is safe,effective and feasible for old radial head fractures associated with elbow dysfunction.
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