前后联合入路和后外侧入路治疗儿童陈旧性孟氏骨折的回顾性研究  

Retrospective Study of Henry Approach and Boyd Approach for Missed Monteggia Lesions in Children

作　　者：何勇[1] 蒋国鹏 李卫平[1] 陈志龙[1] 陈世海[1] 赵军[1] 王华明[1] 张辰 HE Yong;JIANG Guopeng;LI Weiping;CHEN Zhilong;CHEN Shihai;ZHAO Jun;WANG Huaming;ZHANG Chen(Gansu Provincial Hospital of Traditional Chinese Medicine,Lanzhou 730050,China)

机构地区：[1]甘肃省中医院,兰州730050

出　　处：《中国中医骨伤科杂志》2024年第6期74-79,共6页Chinese Journal of Traditional Medical Traumatology & Orthopedics

摘　　要：目的:回顾性分析尺骨截骨矫形、桡骨头切开复位治疗儿童陈旧性孟氏骨折的临床疗效,并探讨前后联合入路和后外侧入路的优劣。方法:收集2010年1月至2020年1月因陈旧性孟氏骨折就诊,行尺骨截骨矫形、桡骨头切开复位患者,根据桡骨头切开复位入路分为Henry组和Boyd组。对其性别、年龄、体重指数、受伤时间、随访时间、术前及随访末期的肘关节活动范围和梅奥肘关节功能评分以及相关并发症进行统计,采用SPSS21.0进行统计学分析。结果:共有45例患者纳入,其中Henry组24例,Boyd组21例。男27例,Henry组14例,Boyd组13例;女18例,Henry组10例,Boyd组8例。BadoⅠ型33例,其中Henry组17例,Boyd组16例;BadoⅢ型12例,其中Henry组7例,Boyd组5例。两组患者随访末期肘关节活动范围和梅奥肘关节功能评分较术前明显改善,两组间随访末期肘关节活动范围和梅奥肘关节功能评分差异无统计学意义(P>0.05)。术后影像学检查正常者Henry组21例,Boyd组17例;再次半脱位Henry组发生1例,Boyd组2例;再次脱位Henry组发生2例,Boyd组发生2例;Henry组无桡神经损伤发生,Boyd组有1例。结论:对于儿童陈旧性孟氏骨折,不论前后联合入路或者后外侧单一入路均能获得肱桡关系复位,但是后外侧入路具有较多的并发症,前后联合入路能够获得较好的肱桡关系暴露,尤其对于BadoⅠ型和桡神经损伤患者。Objective:The purpose of this study is to investigated clinical effects of ulna osteotomy with open reduction of radial head for neglected Monteggia fracture in children,and preference for Henry approach and Boyd approach by a retrospective study.Methods:From January 2010 to January 2020,search for patients with missed Monteggia fracture and underwent ulnar osteotomy and open reduction of radial head and divided into Henry group and Boyd group according to the open reduction approach for radial head.Gender,age,body mass index(BMI),time of injury,follow-up time,range of motion(ROM)of the elbow and Mayo elbow performance score(MEPS)at pre-operation and the end of follow-up and complications were recorded.SPSS 21.0 was used for statistical analysis.Results:A total of 45 patients were included in the study,24 cases in Henry group and 21 cases in Boyd group,including 27 males,14 cases in Henry group,13 cases in Boyd group;18 females,10 cases in Henry group,8 cases in Boyd group.Bado Ⅰ type 33 cases,including 17 cases in Henry group,16 cases in Boyd group;and 12 cases in Bado Ⅲ group,including 7 cases in Henry group and 5 cases in Boyd group.ROM and MEPS at the end of follow-up were significantly improved in both groups compared with preoperative,however,there was no statistical difference between the two groups at the end of follow-up.Postoperative imaging was normal in Henry group 21 cases,17 cases in Boyd group,and 1 case resubluxation occurred in Henry group,2 cases in Boyd group,and 2 cases redislocation in Henry group,2 cases in the Boyd group,no radial nerve injury in the Henry group,and 1 case in the Boyd group.Conclusions:For neglected Monteggia fracture in children,both approaches can achieve good results,however,Henry approach can achieve better operative field and radial nerve exposure and protection.

关 键 词：儿童 陈旧性孟氏骨折 前后联合入路 后外侧入路 

分 类 号：R683.41[医药卫生—骨科学]