Henry入路环状韧带复位修复治疗儿童孟氏骨折  

Application of annular ligament reposition and repair via Henry’s approach for Monteggia fracture in children

作　　者：岳俊伊 慕明章 孙红梅 姜小艳[1] 陈旭[1] YUE Junyi;MU Mingzhang;SUN Hongmei;JIANG Xiaoyan;CHEN Xu(Department of Orthopedics,Yantaishan Hospital,Yantai Shandong,264000,P.R.China)

机构地区：[1]烟台市烟台山医院骨科,山东烟台264000

出　　处：《中国修复重建外科杂志》2021年第5期562-566,共5页Chinese Journal of Reparative and Reconstructive Surgery

摘　　要：目的探讨Henry入路环状韧带复位修复治疗儿童孟氏骨折的疗效。方法回顾分析2015年5月—2019年6月21例儿童孟氏骨折临床资料,均采用Henry入路切开复位桡骨头并环状韧带复位修复。其中男11例,女10例;年龄4岁5个月~14岁4个月,平均8岁1个月。致伤原因:摔伤17例,高处坠落伤4例。新鲜骨折16例,陈旧性骨折5例。骨折Bado分型:Ⅰ型14例,Ⅲ型7例。术前MRI检查及术中观察明确环状韧带完整。术后记录骨折愈合情况、肘关节活动度、并发症发生情况,按照Mackay功能评分系统评价疗效。结果术后切口均Ⅰ期愈合,无桡神经损伤等并发症发生。患儿均获随访,随访时间12~25个月,平均15个月。术后均未出现桡骨头脱位及半脱位。末次随访时,陈旧性骨折者肘关节屈伸活动度由术前(92.6±11.2)°提高至(123.6±11.6)°、前臂旋转活动度由术前(96.8±11.8)°提高至(129.8±5.9)°,手术前后差异均有统计学意义(t=7.672,P=0.002;t=9.487,P=0.001)。新鲜骨折者肘关节屈伸活动度为139°~156°,平均145°;前臂旋转活动度为158°~168°,平均162°。根据Mackay功能评分系统评定疗效,获优17例、良4例,优良率达100%。X线片复查显示无骨不连、异位骨化以及内固定物松动、脱出等并发症发生,新鲜骨折尺骨断端及陈旧性骨折截骨均顺利愈合。结论儿童孟氏骨折中环状韧带主体均完整,相比环状韧带重建,经Henry入路复位修复更接近环状韧带正常解剖状态且具有创伤小、并发症少等优点,是一种有效的治疗方法。Objective To explore the effectiveness of annular ligament reposition and repair via Henry’s approach for Monteggia fracture in children. Methods A clinical data of 21 children with Monteggia fractures was retrospectively analysed, who underwent open reduction of the radial head and annular ligament reposition and repair via Henry’s approach between May 2015 and July 2019. There were 11 boys and 10 girls with an average age of 8 years and 1 month(range, 4 years and 5 months to 14 years and 4 months). The fracture was caused by falling in 17 cases and by falling from height in 4 cases. There were 16 fresh fractures and 5 old fractures. The Monteggia fractures were rated as Bado typeⅠin 14 cases and Bado type Ⅲ in 7 cases. Preoperative MRI examination and intraoperative observation confirmed that the annular ligament was intact. After operation, the fracture healing, elbow range of motion(ROM),and complications were recorded, and the effectiveness was evaluated according to the Mackay’s function scoring system. Results The incisions healed by first intention after operation, and there was no complication such as radial nerve injury. All children were followed up 12-25 months, with an average of 15 months. No dislocation or subluxation of the radial head occurred after operation. At last follow-up, the ROM of elbow flexion and extension of the children with old fractures increased from(92.6±11.2)° before operation to(123.6±11.6)°, and the ROM of forearm rotation from(96.8±11.8)° to(129.8±5.9)°;the differences between pre-and post-operation were significant(t=7.672, P=0.002;t=9.487,P=0.001);the ROM of elbow flexion and extension of the children with fresh fractures was 139°-156°(mean, 145°);the ROM of forearm rotation was 158°-168°(mean, 162°). According to Mackay’s criteria, 17 cases were excellent and4 cases were good, with an excellent and good rate of 100%. X-ray film examination showed no nonunion, heterotopic ossification, or loosening of internal fixation after operation. The ulnar fr

关 键 词：孟氏骨折 Henry入路 环状韧带 复位 修复 儿童 

分 类 号：R726.8[医药卫生—儿科]