非尺骨截骨手术治疗儿童BadoⅠ型陈旧性孟氏骨折  

Surgical therapy without ulnar osteotomy for Bado type I old Monteggia fractures in children

作　　者：仝彦格 万富安 时国富 杨建平[2] 任飞 刘欢欢 李保华 郭天贵 TONG Yan-ge;WAN Fu-an;SHI Guo-fu;YANG Jian-ping;REN Fei;LIU Huan-huan;LI Bao-hua;GUO Tian-gui(Luoyang Orthopedic Hospital of Henan Province,Luoyang 471000,Henan,China;Tianjin Hospital,Tianjin 300000,China)

机构地区：[1]河南省洛阳正骨医院(河南省骨科医院),河南洛阳471000 [2]天津市天津医院,天津300000

出　　处：《中国矫形外科杂志》2025年第7期649-652,共4页Orthopedic Journal of China

基　　金：河南省医学科技攻关计划项目(编号:LHGJ20230491)。

摘　　要：[目的]探讨非尺骨截骨手术治疗儿童BadoⅠ型陈旧性孟氏骨折的可行性及临床疗效。[方法]回顾性分析2016年9月—2021年9月本科采用非尺骨截骨,即肱桡关节切开桡骨头复位内固定治疗的29例儿童BadoⅠ型陈旧性孟氏骨折患者的临床资料。评价临床及影像结果。[结果]所有患者均顺利完成手术,无血管、神经损伤等围手术期并发症。随访时间平均(16.2±7.4)个月,随术前、术后12个月和末次随访的时间推移,肘关节HSS评分[(84.0±5.3),(92.1±3.4),(93.3±2.6),P<0.001]、肘关节最大屈曲ROM[(114.0±11.8)°,(139.0±2.4)°,(139.4±1.9)°,P<0.001]显著增加,肘关节最大伸直ROM[(5.8±3.9)°,(3.1±1.6)°,(2.9±1.7)°,P<0.05]显著减小。而前臂最大旋前ROM明显受限(P<0.05),前臂最大旋后ROM无显著变化(P>0.05)。随访过程中,未见桡骨头脱位复发、肘关节僵硬、肘外翻等晚期并发症。影像方面,术后桡骨轴线均通过肱骨小头中心,尺骨畸形角度随时间推移显著减小[(4.6±1.4)°,(2.5±0.8)°,(2.1±1.0)°,P<0.001]。[结论]非尺骨截骨手术治疗儿童BadoⅠ型陈旧性孟氏骨折具有可行性,临床效果满意。[Objective]To investigate the feasibility and clinical efficacy of surgical therapy without ulnar osteotomy for Bado type I old Monteggia fractures in children.[Methods]A retrospective study was conducted on 29 children who had Bado type I old Monteggia fractures treated surgically involving radial head reduction and internal fixation without ulnar osteotomy in our hospital from September 2016 to September 2021.The clinical and imaging data were evaluated.[Results]All patients were successfully operated without perioperative complications such as vascular and nerve injury and followed up for a mean of(16.2±7.4)months.With time elapsed preoperatively,12 months postoperatively and the last follow-up,the elbow HSS score[(84.0±5.3),(92.1±3.4),(93.3±2.6),P<0.001]and elbow maximal flexion ROM[(114.0±11.8)°,(139.0±2.4)°,(139.4±1.9)°,P<0.001]were significantly increased,while the forearm maximal pronation ROM was significantly decreased(P<0.05),and the forearm maximal supination ROM remained unchanged significantly(P>0.05).During the follow-up,there were no late complications such as recurrence of radial head dislocation,elbow stiffness and elbow valgus.Radiographically,all radial axes passed through the center of the humerus postoperatively,and the ulnar deformity angle decreased significantly over time[(4.6±1.4)°,(2.5±0.8)°,(2.1±1.0)°,P<0.001].[Conclusion]Surgical therapy without-ulnar osteotomy is feasible for Bado type I old Monteggia fracture in children with satisfactory clinical results.

关 键 词：儿童 陈旧性孟氏骨折 桡骨头脱位 切开复位 非截骨 

分 类 号：R681.41[医药卫生—骨科学]