改良术式治疗陈旧性孟氏骨折疗效观察  

EFFECTIVENESS OF MODIFIED OPERATION FOR TREATMENT OF OLD MONTEGGIA FRACTURE

作　　者：韦仕战[1] 唐毓金[1] 彭维波[1] 班华登[1] 

机构地区：[1]右江民族医学院附属医院骨科,广西百色533000

出　　处：《中国修复重建外科杂志》2016年第1期50-53,共4页Chinese Journal of Reparative and Reconstructive Surgery

摘　　要：目的探讨采用一种改良术式治疗陈旧性孟氏骨折的临床疗效。方法 2006年3月-2013年12月,采用改良扩大切取前臂带蒂深筋膜瓣重建环状韧带和修复肘部桡侧副韧带复合体,尺骨截骨延长、骨痂回植钢板内固定术治疗40例陈旧性孟氏骨折患儿。其中男26例,女14例;年龄2~10岁,平均4岁。致伤原因：摔伤24例,交通事故伤8例,高处坠落伤8例。均为单侧伸直型骨折;病程2~11个月,平均4个月。合并桡神经麻痹4例。结果术后患儿切口均Ⅰ期愈合,无桡神经麻痹、肌筋膜室综合征、手部伸肌肌力下降等早期并发症发生。患儿均获随访,随访时间1~5年,平均2.5年。X线片示骨折均愈合,愈合时间10~20周,平均15周。随访期间3例发生再脱位,无手部肌肉粘连致手功能障碍及桡骨小头瓶颈状改变发生。末次随访时根据Mackay等功能评定标准评定,获优32例,良5例,差3例,优良率92.5%。结论采用改良术式治疗陈旧性伸直型孟氏骨折,肱桡关节匹配程度良好,可不作内固定处理,临床疗效良好。Objective To investigate the effectiveness of a modified surgical treatment of old Monteggia fracture. Methods Between March 2006 and December 2013, 40 cases of old Monteggia fracture were treated with modified operation. Modified operation procedure included expanding excision of pedicled forearm fascia flap for reconstruction of the annular ligament and repair of elbow radial lateral collateral ligament complex and extending osteotomy of the ulna, callus replantation, and internal fixation with steel plate. There were 26 boys and 14 girls, aged 2-10 years with an average age of 4 years. Injury was caused by falling in 24 cases, by traffic accident in 8 cases, and by falling from height in 8 cases. The disease duration was 2-11 months（mean, 4 months）. Four patients had combined radial nerve palsy. Results Incision healed by first intention after operation, without early complication of radial nerve palsy, fascial compartment syndrome, or decreased hand extensor muscle strength. All the children were followed up 1-5 years（mean, 2.5 years）. X-ray films showed fracture healing, and the healing time was 10-20 weeks（mean, 15 weeks）. During followup, 3 cases had re-dislocation. Neither hand dysfunction caused by hand muscle adhesion nor radial head bottleneck shape change was found. On the basis of the functional evaluation criteria by Mackay, the results were excellent in 32 cases, good in 5 cases, and poor in 3 cases; the excellent and good rate was 92.5% at last follow-up. Conclusion The modified surgical treatment of old Monteggia fracture is an effective method, with good matching of humeroradial joint and without internal fixation of the humeroradial joint.

关 键 词：陈旧性孟氏骨折 截骨 植骨 环状韧带 固定 

分 类 号：R726.8[医药卫生—儿科]