波及肱尺关节的成人向后孟氏骨折的诊断和治疗  

Diagnosis and treatment of BadoⅡMonteggia fracture with involvement of humeroulnar articulation

作　　者：何建平 公茂琪[2] 季尚蔚 He Jianping;Gong Maoqi;Ji Shangwei(Department of Orthopedics,Pinggu District Hospital,Beijing 101200,China;Department of Traumatic Orthopedics,Beijing Jishuitan Hospital,Beijing 100035,China)

机构地区：[1]北京市平谷区医院骨科,北京101200 [2]北京积水潭医院创伤骨科,北京100035

出　　处：《中国医刊》2021年第2期154-156,共3页Chinese Journal of Medicine

摘　　要：目的探讨波及肱尺关节的成人向后孟氏骨折的诊断和治疗情况。方法回顾性分析2014年1月至2019年12月北京积水潭医院收治的16例波及肱尺关节的成人向后孟氏骨折患者的病例资料,所有患者均采用后正中入路手术,尺骨近端应用鹰嘴解剖钢板内固定,必要时辅以克氏针张力带,冠突骨折根据骨折块的大小分别应用钢板、螺钉、克氏针内固定,桡骨头骨折根据粉碎及移位程度选择Herbert钉固定或桡骨头置换。术后随访6~75个月,平均42.1个月,记录患者的肘关节屈伸、旋转活动范围及Mayo肘关节功能评分情况。结果末次随访时16例患者的肘关节屈伸范围为55°~150°,平均99.4°,前臂旋转活动范围为80°~180°,平均137.8°。Mayo肘关节功能评分优9例、良4例、可3例,优良率为81.25%。结论波及肱尺关节的向后孟氏骨折病情复杂,治疗难度高,术中应尽可能恢复尺骨近端的对位对线,有效恢复尺骨鹰嘴滑车切迹的解剖关系至关重要,桡骨头粉碎及移位不明显时尽可能行Herbert钉内固定,严重粉碎移位时可予以桡骨头置换。Objective This study aims to explore the diagnosis and treatment of BadoⅡMonteggia fracture.Method The authors retrospectively reviewed 16 cases of adult BadoⅡMonteggia fracture with involvement of humeroulnar articulation admitted and treated in our hospital from Jan 2014 to Dec 2019,with mean follow-up time of 42.1 months(6-75 months).The authors adopted the posterior approach and used plate fixation on the olecranon with assistance of tension band and K-wire when necessary.The coronoid process was fixed by plate,nail or K-wire depends on the status of the fracture.The Herbert nail or radial head replacement was applied to the radial head,had the fracture occurred.Result The mean follow-up time,ranged from 6 to 75 months,was 42.1 months.The average flexionextension arc was 99.4 degree,ranged from 55 to 150 degree.The mean pronation-supination arc was 137.8 degree,ranged from 80 to 180 degree.According to the Mayo Elbow Performance Score,there were 9 cases with excellent outcome,4 good and 3 acceptable.81.25%patients had excellent or good result.Conclusion The BadoⅡMonteggia fracture involving the articular surface is complex and difficult to treat.When combined with humeroulnar dislocation,the post-operative flexion-extension range of motion is usually worse.In the surgical procedure,it is imperative to fully restore the structure of the proximal ulna and re-establish the anatomical alignment of the olecranon and the trochlear notch.The author don’t recommend the excision of the radial head.The radial head should,when possible,fixed with Herbert nail,or replaced with a prosthetic radial head.

关 键 词：孟氏骨折 肱尺关节 脱位 冠突 桡骨头 

分 类 号：R683.41[医药卫生—骨科学]