后孟氏骨折损伤的临床特征及手术疗效分析  

Analysis of the clinical characteristics and postoperative effect of posterior Monteggia fracture

作　　者：郑金文[1] 向明[1] 陈杭[1] 胡晓川[1] 李一平[1] 张清[1] 杨金松 Zheng Jinwen;Xiang Ming;Chen Hang;Hu Xiaochuan;Li Yiping;Zhang Qing;Yang Jinsong(Department of Upper Extremity,Sichuan Orthopaedic Hospital,Chengdu 610041,China)

机构地区：[1]四川省骨科医院上肢科,成都610041

出　　处：《中华肩肘外科电子杂志》2023年第4期338-343,共6页Chinese Journal of Shoulder and Elbow(Electronic Edition)

摘　　要：目的探讨后孟氏骨折损伤的临床特征及手术疗效。方法回顾性分析2016年1月至2020年1月收治的19例成人后孟氏骨折损伤的患者资料。其中男13例、女6例;平均年龄(46.8±15.6)岁(21~69岁)。尺骨骨折使用解剖锁定钢板固定,桡骨头骨折进行内固定或置换,冠状突骨折使用螺钉或微型钢板固定,内外侧副韧带损伤采用锚钉修复。分析患者的一般资料和骨折脱位的形态特征,并随访术后肘关节功能。结果Jupiter IIA/IID型占比89%(17例),合并尺骨鹰嘴和冠突骨折、桡骨头骨折后脱位、肱尺关节脱位和外尺侧副韧带撕裂的联合损伤。所有患者获平均(20.8±5.3)个月(11~37个月)随访。肘关节平均屈曲为(117.1±18.5)°(90~140°),平均伸直为(18.2±12.7)°(5~45°),平均旋前为(54.2±19.5)°(10~70°),平均旋后为(62.1±20.4)°(10~80°)。Broberg-Morrey肘关节功能系统评分平均为(79.8±11.5)分(57~93分)。7例患者(37%)发生术后异位骨化,肘关节活动度和功能评分均显著低于无异位骨化的患者(P<0.05)。结论Jupiter IIA/IID型损伤往往涉及尺骨鹰嘴和冠突骨折、桡骨头骨折后脱位、肱尺关节脱位和外尺侧副韧带撕裂的联合损伤。正确识别损伤特征,并通过合适的手术治疗可以取得良好的效果。Background Monteggia fractures initially referred specifically to fractures of the proximal third of the ulna combined with anterior dislocation of the radial head.In 1967,Bado categorized this injury into four types based on the direction of radial head dislocation and whether there was an associated fracture of the radial shaft.Among these types,Bado II,involving posterior dislocation of the radial head in Monteggia injuries,is the most common and complex.Subsequently,Jupiter and others further subdivided Monteggia injuries with posterior dislocation of the radial head based on the location of the ulnar fracture.Most scholars acknowledge that a series of injuries involving proximal ulnar fractures combined with posterior dislocation of the radial head,radial head fractures,or coronoid process fractures should be collectively referred to as posterior Monteggia fracture-dislocations.Dong Jingming and others further proposed that classic Monteggia fractures involve ulnar fractures with a dislocation of the proximal radioulnar joint.When combined with posterior dislocation of the radial head,it is termed posterior Monteggia fracture,whereas those without dislocation of the proximal radioulnar joint are termed post-ulnar proximal fractures with dislocation.Due to the various complex patterns of fractures and dislocations involving the proximal ends of the ulna and radius in posterior Monteggia fractures,it is crucial to understand the extent and nature of the injury.Only by restoring the bony structure and elbow joint stability can satisfactory clinical outcomes be achieved.Objective To investigate the clinical features and operative effect of posterior Monteggia fracture.Methods A retrospective analysis was conducted on data from 19 adult patients with posterior Monteggia fractures treated between January 2016 and January 2020.Among them were 13 males and 6 females,with an average age of(46.8±15.6)years(ranging from 21 to 69 years old).Anatomical locking plates were used for ulnar fractures,while internal fixation

关 键 词：后孟氏骨折 肘关节 骨折脱位 手术 

分 类 号：R68[医药卫生—骨科学]