儿童陈旧性孟氏骨折尺骨截骨内固定与非内固定比较  

Comparison of ulnar osteotomy with and without internal fixation for old Monteggia fractures in children

作　　者：雍明 楼跃 唐凯 林刚 YONG Ming;LOU Yue;TANG Kai;LIN Gang(Department of Orthopedics,Children's Hospital of Nanjing Medical University,Nanjing 210000,China)

机构地区：[1]南京医科大学附属儿童医院骨科,江苏南京210000

出　　处：《中国矫形外科杂志》2022年第20期1842-1847,共6页Orthopedic Journal of China

摘　　要：[目的]比较内固定与非内固定尺骨截骨治疗儿童陈旧性孟氏骨折的疗效。[方法]2018年7月—2020年7月,79例儿童陈旧性孟氏骨折患者均接受尺骨截骨,肱桡关节复位和石膏外固定治疗。根据医患沟通结果,42例术中对截骨行内固定,37例术中未对截骨行内固定。比较两组围手术期、随访及影像资料。[结果]所有患者均顺利完成手术。非固定组手术时间、切口长度、透视次数、住院时间均显著优于固定组(P<0.05)。患者均获随访12个月以上,非固定组恢复术完全负重活动时间显著早于固定组(P<0.05)。随时间推移,两组患者前臂旋前、旋后、肘屈伸ROM及Mayo评分均显著增加(P<0.05),相应时间点,两组间上述指标的差异均无统计学意义(P>0.05)。影像方面,术后随时间推移,两组患者术后RCL对合与RCC程度均显著改善(P<0.05)。末次随访时,非固定组的RCL对合与RCC程度均显著优于固定组(P<0.05)。非固定组截骨影像愈合时间显著早于固定组(P<0.05)。[结论]对于儿童陈旧性孟氏骨折手术治疗,尺骨截骨非内固定的临床效果优于截骨内固定。[Objective]To compare the efficacy of ulna osteotomy with and without internal fixation for old Monteggia fractures in chil⁃dren.[Methods]From July 2018 to July 2020,a total of 79 children underwent ulnar osteotomy and open radiocapitellar reduction com⁃bined plaster cast fixation for old Monteggia fractures.According to preoperative doctor-patient communication,42 children had osteotomy site fixed with internal implant(fixation group),while the other 37 had osteotomy performed only without internal fixation(the non-fixation group).The perioperative,follow-up and imaging data of the two groups were compared.[Results]All patients had the operations complet⁃ed successfully.The non-fixation group proved significantly superior to the fixation group in terms of operation time,incision length,times of fluoroscopy,incision healing and hospital stay(P<0.05).All the patients were followed up for more than 12 months.The non-fixation group resumed full weight-bearing activity significantly earlier than the fixation group(P<0.05).Th range of motions(ROMs),including pronation,supination,elbow flexion and extension,as well as Mayo elbow score significantly increased over time in both groups(P<0.05),however,there were no statistically significant differences in abovesaid items between the two groups at any corresponding time points(P>0.05).Radiographically,the alignments in term of radiocapitellar line(RCL)and extent of radiocapitellar congruence(RCC)significantly improved in both groups over time(P<0.05),which in the non-fixation group was significantly superior to those in the fixation group at the latest follow-up(P<0.05).In addition,the non-fixation group got bony healing of the osteotomy site on images significantly earlier than the fixation group(P<0.05).[Conclusion]The clinical outcomes of ulna osteotomy without internal fixation are considerably better than those with internal fixation in the surgical treatment of old Monteggia fractures in children.

关 键 词：陈旧性孟氏骨折 尺骨截骨 内固定 非内固定 儿童 

分 类 号：R683.41[医药卫生—骨科学]