儿童陈旧性孟氏骨折的病理形态观察及治疗分析  

The Pathomorphism Change and Treatment of Old Monteggia Fracture in Children

作　　者：邹勇根[1] 郭跃明[1] 李伟强[1] 王志远[1] 何汉晖[1] 

机构地区：[1]广东省佛山市中医院骨科,广东佛山528000

出　　处：《中国现代医生》2009年第3期12-14,共3页China Modern Doctor

基　　金：佛山市卫生局科研项目(编号:2006089)

摘　　要：目的分析儿童陈旧性孟氏骨折的病理形态改变,并探讨其治疗方法,以提高临床疗效。方法随机将46例病程在3个月～1年的陈旧性孟氏骨折的患儿分为两组,A组采用尺骨上段"Z"形截骨矫形内固定、桡骨头复位术,B组采用尺骨上段"Z"形截骨矫形、桡骨头复位内固定+环状韧带修补术。术前、术后分别记录每例患者的尺骨上段、桡骨和肱骨小头的病理形态改变以及前臂和肘关节功能恢复等情况。结果46例患者均有不同程度尺骨上段向前外侧成角、桡骨过度增长和患肘关节退行性等改变。40例完成随访,随访21.6个月(6～32个月),40例患者尺骨截骨处均愈合;A组19例患者术后复发桡头脱位者8例,功能优良率达57.9%(11/19);B组21例患者术后复发桡头脱位者2例,功能优良率达90.5%(19/21)。结论尺骨上段"Z"形截骨矫形、桡骨头复位内固定+环状韧带重建术能够显著提高儿童陈旧性孟氏骨折的临床疗效。尽早手术有利于儿童陈旧性孟氏骨折的病理形态修复。Objective To analyse the pathomorphism change of old Monteggia fracture in children and study the treatment methods to increase clinic effects. Methods The 46 cases from 3 months to 1 year ＇after injury were divided into two groups by randomization. The cases in group A were treated by proximal ulna Z-shaped osteotomy correction with radial-head reduction and internal fixation. The other cases in group B were treated by proximal ulna Z-shaped osteotomy correction with radial head reduction and internal fixation in addition to annular ligament reconstruction.We recorded the pathomorphism changes of the proximal ulna and radial head and humeral eapitellum,and recorded the function recovery of injury, fnrearm and elbow pre- and post-operation. Results All of this cases were found the anterolateral angulation of the proximal ulna and the super-development radius and the degenerate change of the elbow joint. 40 cases were finished follow-up 20.6 months（from 6 to 32 months ）. The osteotomic part of the proximal ulna were healed in all of the 40 cases. There were 2 eases recurrent dislocation of radial head in group A, and 8 cases recurrent dislocation of radial head in group B. The excellent and good function rate was 57.9% and 90.5% in two groups respectively. Conclusion Z-shaped osteotomy correction proximal ulna and reduction radial head in addition to annular ligament reconstruction is a good method for old monteggia fracture in children. Early operation as soon as possible is good helpful of the pathomorphism repairment.

关 键 词：儿童 陈旧性孟氏骨折 病理形态 治疗 

分 类 号：R726.8[医药卫生—儿科]