尺骨成角延长截骨治疗儿童陈旧性孟氏骨折

目的探讨应用尺骨截骨后成角延长钢板内固定术治疗儿童陈旧性孟氏骨折的疗效。方法对12例陈旧性孟氏骨折患儿(病程45 d~18个月)行手术截骨矫正内固定治疗。结果患儿均获随访,时间10~18个月。根据Mackay疗效评定标准:优11例,良1例。结论尺骨截骨成角延长治疗儿童陈旧性孟氏骨折,通过手术矫正尺骨畸形无需重建环状韧带,能够恢复正常的肱桡关节关系,改善关节功能。     

儿童陈旧性孟氏骨折的外科治疗

目的研究和探讨儿童陈旧性孟氏骨折的手术治疗方法。方法本组16例患儿,2~16岁,采用Boyd切口显露桡骨小头肱桡关节及尺骨上段,在骨折成角顶部行斜形或楔形型截骨,桡骨小头解剖复位,行尺骨内固定,从肱三头肌腱的外侧游离长8cm、宽1cm的腱性部分重建环状韧带,石膏固定4~6周。结果术后随访0.5~1.5年,优75%,良18.7%,可9.1%,优良率93.7%。结论尺骨截骨延长,同时用肱三头肌腱重建环状韧带治疗儿童陈旧性孟氏骨折疗效满意。     

改良手术治疗儿童陈旧性孟氏骨折

目的探讨改良手术治疗儿童陈旧性孟氏骨折的疗效。方法23例儿童陈旧性孟氏骨折在传统手术尺骨延长、桡骨头复位、环状韧带重建的基础上，根据桡骨畸形情况，增加桡骨旋转截骨术。结果23例随访6～36个月（平均20个月），根据临床与X线检查，优17例，良5例，可1例。结论通过桡骨旋转截骨改良儿童陈旧性孟氏骨折的手术治疗，操作方法简单实用，临床疗效确切，可在临床推广应用。     

儿童陈旧性孟氏骨折的手术改良

[目的]探讨手术解决儿童陈旧性孟氏骨折更佳方法。[方法]对23例儿童陈旧性孟氏骨折，在传统手术治疗三原则即尺骨延长、桡骨头复位、环状韧带重建的基础上增加桡骨旋转截骨术，随访治疗效果。[结果]本组23例，随访6～36个月，平均23个月，优良率为95．7％，效果满意。[结论]通过桡骨旋转截骨改良儿童陈旧性孟氏骨折的手术治疗，操作方法简单实用，临床疗效确切，可在临床推广应用。     

低龄儿童2年以内陈旧性孟氏骨折的手术治疗

目的探讨低龄儿童2年以内陈旧性孟氏骨折手术治疗的疗效。方法对38例2年以内陈旧性孟氏骨折低龄患儿采取尺骨近端截骨克氏针内固定,桡骨小头切开复位、肱桡关节克氏针内固定。结果 38例全部得到随访,时间2~12个月。术后2例发生桡骨小头半脱位。4例桡神经损伤患儿功能完全恢复,其余患儿肘关节无畸形,无疼痛。肘关节伸直活动范围0°~20°(6°±4°),屈曲活动120°~135°(130°±5°),旋前平均80°±5°,旋后平均85°±5°。根据Mackay标准评定:优30例(78.9%),良6例(15.8%),差2例(5.3%)。结论尺骨近端截骨克氏针内固定手术治疗低龄儿童2年以内陈旧性孟氏骨折,疗效良好。     

2种截骨方式治疗儿童陈旧性孟氏骨折的疗效比较

目的比较尺骨截骨延长与桡骨短缩截骨术治疗儿童陈旧性孟氏骨折的临床疗效。方法自2005-06—2013-05共诊治儿童陈旧性孟氏骨折28例,采用尺骨截骨延长13例,采用桡骨短缩截骨15例。结果术后切口均一期愈合,28例均获得随访,尺骨截骨组随访6~32个月,平均17个月,截骨处均一期愈合,平均愈合时间3.8周;采用Mackay进行效果评定:优11例,良1例,差1例。桡骨截骨组随访5~34个月,平均16个月,桡骨小头骨折均维持良好复位,截骨处一期愈合,平均愈合时间4周;采用Mackay进行效果评定:优9例,良3例,差3例。结论采用尺骨截骨延长较桡骨短缩截骨操作简单且能获得更好的临床疗效。     

56例儿童陈旧孟氏骨折临床诊治分析

[目的]总结分析56例儿童陈旧孟氏骨折患儿骨折的原因和治疗效果,为儿童陈旧孟氏骨折的临床诊治提供支持。[方法]选取2008年1月~2013年12月本院收治的56例儿童陈旧孟氏骨折患儿病例。分析骨折原因。给予尺骨截骨术治疗,术后随访2年。采用Macky和Mayo的标准对肘关节功能进行评价,并观察手术前、后肘关节屈伸功能和前臂旋转功能的改善情况。[结果]56例陈旧孟氏骨折患儿中,24例被误诊为尺骨或尺桡骨骨折,13例为手法复位不完全,10例被误诊为软组织损伤,5例为石膏松动发生移位,4例为塑型不良。尺骨截骨术后随访2年,骨折部位均全部愈合。术后肘关节屈伸功能和前臂旋转功能均显著改善(P0.05)。Macky评分优良率为96.4%,Mayo评分优良率为94.6%。[结论]儿童陈旧孟氏骨折多由错诊、漏诊、处理不当引起,应对患儿进行全面、细致的检查,以避免陈旧孟氏骨折的发生。尺骨截骨术对于儿童陈旧孟氏骨折有满意的临床效果。     

尺骨植骨延长治疗陈旧性孟氏骨折

目的探讨应用尺骨植骨延长术治疗陈旧性孟氏骨折的临床疗效。方法1998年7月～2003年7月采用尺骨截骨、取髂骨植骨延长钢板内固定治疗14例陈旧性孟氏骨折患者,采用桡骨短缩后、尺骨以取出的桡骨块植骨延长钢板内固定治疗者2例,均不行环状韧带重建。结果16例患者获1～5年(平均2.5年)随访。根据Mackay等功能评定标准,本组优10例,良5例,差1例,优良率为93.8%。结论对于陈旧性孟氏骨折而言,术中纠正尺骨短缩畸形是手术的关键,术后早期康复训练是保证疗效的基础。     

小儿孟氏骨折的修复与重建

报道１９８０年～１９９２年手术治疗６２例小儿孟氏骨折。其中新鲜孟氏骨折１８例，陈旧性孟氏骨折４４例。行桡骨小头及尺骨解剖复位或截骨延长内固定手术，环状韧带重建，桡神经深支修复术。经随访１年～１２年，疗效优良率为９３％。简要介绍了手术方去，讨论了小儿孟氏骨折的早期诊断与及时有效治疗的重要性。尺骨牢固固定和环状韧带修复或重建是防止桡骨小头再脱位的关键。术后缩短外固定时间，积极进行功能练习是提高疗效的重要措施。     

Boyd入路切开复位尺骨截骨延长治疗儿童陈旧孟氏骨折

目的 探讨经Boyd入路切开复位尺骨斜行截骨延长术治疗儿童陈旧孟氏骨折的临床疗效。方法 采用经Boyd入路切开复位尺骨斜行截骨延长术治疗26例陈旧孟氏骨折患儿。术后12个月根据Kim评分标准评价肘关节功能。结果 患儿均获得随访,时间12～36个月。截骨处均获得骨性愈合。术后12个月根据Kim评分标准评价肘关节功能:优17例,良7例,可2例,优良率为24/26。拆除石膏后发生桡骨头再脱位1例、半脱位1例。2例截骨处延迟愈合,采用管型石膏固定6个月后愈合。均未发生桡神经损伤、感染等并发症。结论 经Boyd入路切开复位尺骨斜行截骨延长术治疗儿童陈旧孟氏骨折术后功能恢复好,并发症少,可较快恢复肘关节及前臂功能。     

Missed Monteggia fracture in children: Is annular ligament reconstruction always required?

Background:

Chronic (neglected) radiocapitellar joint dislocation is one of the feared complications of Monteggia fractures especially when associated with subtle fracture of the ulna bone. Many treatment strategies have been described to manage chronic Monteggia fracture and the need for annular ligament reconstruction is not always clear. The purpose of this study is to highlight the management of missed Monteggia fracture with particular emphasis on utility of annular ligament reconstruction by comparing the two groups of patients.

Materials and Methods:

In a prospective study 12 patients with mean age of 7.4 years, who presented with neglected Monteggia fractures, were studied. All children underwent open reduction of the radiocapitellar joint. Five children (Group A) were treated with angulation-distraction osteotomy of ulna and annular ligament reconstruction and six cases (Group B) required only angulation-distraction osteotomy of ulna without ligament reconstruction. In one case an open reduction of the radiocapitellar joint was sufficient to reduce the radial head and this was included in Group B. The gap between injury and presentation was from 3 months to 18 months (mean 9 months). Ten patients were classified as Bado I, and one each as Bado II and III respectively. We used the Kim''s criteria to score our results.

Result:

The mean follow-up period was 22 months. All ulna osteotomies healed uneventfully. The mean loss of pronation was 15 degree in Group A and 10 degree in Group B. Elbow flexion improved from the preoperative range and no child complained of pain, deformity and restriction of activity. The elbow score was excellent in 10 cases, and good in two cases.

Conclusion:

Distraction-angulation osteotomy of the ulna suffices in most cases of missed monteggia fracture and the need for annular ligament reconstruction is based on intraoperative findings of radial head instability.     

儿童陈旧性孟氏骨折的治疗探讨

目的探讨儿童陈旧性孟氏骨折手术治疗的方法及疗效。方法2000年3月至2005年5月间对15例儿童陈旧性孟氏骨折采用切开复位、尺骨截骨、环状韧带修复或成形术。结果所有病例均获随访10个月至5年,平均24个月,优11例,良3例,差1例,优良率93.3%。尺骨截骨均愈合,无神经损伤。结论对儿童陈旧性孟氏骨折应早期进行手术复位,尽早恢复肘关节及前臂的解剖,以利功能恢复。为减少陈旧性孟氏骨折的发生率,必须强调提高对新鲜孟氏骨折的诊断与治疗水平。     

Missed Monteggia injuries

The classical Monteggia injury comprises a dislocation of the radial head with an associated fracture of the ulna. In the variant type, there is no ulnar fracture merely plastic deformation. We performed a retrospective study of all Monteggia injuries from 1992 to 2001. A total of 39 were reviewed, of which 8 were missed (1 classical and 7 variant). Of those, five were male and three female with a mean age of 6.3 years. The mean follow-up was 2.5 years, with a mean interval between injury and diagnosis of 33.5 weeks. Two Monteggia injuries diagnosed within 4 weeks were successfully treated by closed manipulation. The other six required ulnar osteotomy, repair of the annular ligament and stabilisation of the radial head with a transcapitellar pin. A protocol for the diagnosis of Monteggia injuries is described. Doubtful cases require an immediate review since early treatment improves the outcome. Acceptable clinical and radiological results in late diagnosed Monteggia injuries can result from ulnar osteotomy, open reduction of the radial head with repair of the annular ligament and transcapitellar pin stabilisation of the reduced radial head.     

Monteggia''s骨折脱位的相关内容回顾

Monteggia’s骨折脱位是指任何部位的尺骨骨折合并桡骨头脱位。这种累及前臂和肘部的损伤并不常见，其发生率约占前臂骨折总数的5％。本文通过回顾Monteggia’s骨折脱位的历史发展，进一步明确了其定义分型、损伤机制和治疗原则，并对现有的治疗方法和预后评价标准进行了总结，并指出治疗的关键是及时诊断和及时治疗，使尺骨获得优良的解剖复位和稳定固定，另外必须重视对发生在肘关节水平的合并损伤的处理，包括冠状突骨折、桡骨头骨折、肱尺关节后外侧旋转不稳定等。而尺骨的粉碎骨折合并桡骨头骨折、冠状突骨折都将明显影响预后。     

Monteggia fracture dislocation equivalents ---analysis of eighteen cases treated by open reduction and internal fixation

Objective: Monteggia fracture dislocation equivalent, though already described by Bado, is still an unclassified entity. We aimed to retrospectively analyze 18 cases of Monteggia variants and discuss the injury mechanisms, management, and outcome along with a re view of the literature. Methods: A retrospective record of Monteggia fracture dislocation (2003-2008) was reviewed from medical record department of our institute. Classic Monteggia fracture dislocation, children below 12 years or adults over 50 years, as well as open grade Ⅱ & Ⅲ cases were excluded from this study. Monteggia variant inclusion criteria included fracture of the proximal ulna together with a fracture of the radial head or neck and skeletal maturity. Totally 26 patients were identified with Monteggia variants and 18 were available for follow-up, including 11 males and 7 females with the mean age of 35 years. The ulna fracture was treated by compression plating along with tension band wiring. Radial head/neck was reconstructed in 12 patients while excised in 6 patients. Results: Follow-up ranged from 1 -4 years, mean 2.6 years. Patients were assessed clinicoradiologically. Mayo Elbow Performance Score was employed to assess the outcomes. At final follow-up, the results were excellent in 10 patients, good in 4, fair in 2 and poor in 2. Mean range of motion of the elbow was 20°, 116°, 50° and 55° for extension, flexion, pronation and supination, respectively. Two patients had complications in the form of heterotopic ossification and stiffness of the elbow. One nonunion ulna, primarily treated by tension band wiring, was managed by refixation with locking reconstruction plate and bone grafting. Bone grafting was only required in this patient for nonunion. Another patient had implants removed on his request. The results in our series closely correlated with extent of intraarticular damage, coronoid fracture and comminuted fractures. Conclusions: Monteggia fracture dislocation equivalents are rare injuries and pre-surgery recognition by radiographs and 3-D CT helps make optimal plan. The poor results usually relate to intraarticular damage, coronoid fractures and comminution of the ulna and radial head fractures.     

Monteggia equivalent fracture associated with Salter I fracture of the radial head

Monteggia fracture is an infrequent lesion, which associates ulna fracture and radial head dislocation. Equivalent Monteggia can occur by associated lesions such as olecranon fracture or radial neck or head fracture. We report an unusual case of Monteggia equivalent lesion associating a fracture of the proximal third of the ulnar shaft and a growth plate fracture Salter I of proximal-radial physis and divergent displacement due to a bottle-opener effect of the radial head over the capitellum during trauma. Surgical care consisted of intramedullary pinning of the radial head and fixation by a plate for ulna with a very good outcome.     

尺骨截骨矫形关节囊松解紧缩治疗儿童陈旧性孟氏骨折

目的 :探讨儿童陈旧性孟氏骨折的手术治疗经验及治疗效果。方法 :自2013年1月至2017年12月治疗32例陈旧性孟氏骨折,男18例,女14例;年龄2~9(5.3±1.2)岁;均无桡神经损伤症状。患者术前症状为肘关节疼痛、畸形,屈伸及前臂旋转受限,X线示尺骨畸形愈合或呈"弓形征",桡骨头脱位或半脱位。术中作尺骨脊后方切口,在尺骨成角畸形最明显处行额状面长斜形截骨,然后采用Boyd切口显露肱桡关节及上尺桡关节,清理关节内的瘢痕组织,复位桡骨头,并在维持肘关节稳定的前提下,对尺骨截骨处进行处理,予钢板螺钉内固定。结果:32例患儿均随访,时间12~24个月,平均14.8个月,其中1例患儿出现术口感染。根据Mackay评定标准:32例患儿术后均无肘、腕关节疼痛症状,29例患儿肘关节屈伸活动度(130±5)°/0°,前臂旋前旋后活动度90°/(85±5)°;2例患儿肘关节屈伸活动度(119°/8°,121°/7°),前臂旋前旋后活动度(90°/75°,85°/60°);1例患者肘关节屈伸活动度90°/10°,前臂旋前旋后活动度80°/60°。优29例,良2例,中1例。结论:尺骨截骨矫形、肘关节后关节囊松解、前关节囊紧缩是治疗儿童陈旧性孟氏骨折的有效方法。     

Posterior interosseous nerve palsy associated with neglected pediatric Monteggia fracture-dislocation: A case report

IntroductionThe main goal of the treatment is the anatomical reduction of the ulna fracture and the radial head dislocation in acute and chronic Monteggia cases. Acute pediatric Monteggia lesions are generally treated non-surgically; however, the treatment of chronic Monteggia is challenging. The aim of this article is to share our experiences about treatment of neglected Monteggia lesion.Presentation of caseA 6-year-old girl who underwent a surgery in our clinic for a missed Bado type-III Monteggia fracture-dislocation of the right elbow with concomitant posterior interosseous nerve (PIN) palsy, which resolved spontaneously after the operation. The operation consisted of open reduction of the radial head, transverse ulnar osteotomy and fixation with an intramedullary Kirchner wire, and annular ligament repair without exploring PIN. The patient was seen in routine follow-up periods until the postoperative first year using plain radiographies. At 16th week follow-up, all functions of the PIN were returned. At first-year follow-up, full range of elbow motion was observed; plain radiographies showed radiocapitellar joint congruency, and Mayo Elbow Performance Index was one hundred.DiscussionTreatment planning for chronic, neglected or missed Monteggia fractures is challenging. There is no consensus about the definitive treatment in the literature.ConclusionWe recommend anatomic and stable restoration of radiocapitellar joint by correcting ulna deformity. Radiocapitellar fixation and PIN exploration may not be necessary in all neglected Monteggia lesions.     

应用双球关节外固定架治疗儿童陈旧孟氏骨折的初步报告

目的 探讨尺骨截骨后、应用舣球关节外固定架治疗儿童陈旧孟氏骨折的临床疗效.方法 2004年6月至2006年6月,采用双球关节外固定架治疗儿童陈旧孟氏骨折7例,平均年龄7.9岁,伤后至手术时间1～30个月(平均11.7个月).患者X线片示桡骨均存在过度增长、尺骨向掌侧甚至桡侧成角畸形.经肘前Henry入路肱桡关节切开、瘢痕清理,尺骨嵴近端矢状面30°斜形截骨、Orthofix双球关节外同定架延长并同时过度矫正尺骨畸形,透视下实时调整尺骨截骨端、于桡骨头稳定复位后紧固火钳螺钉,拍片确认复位效果.术中可游离解剖出环状韧带残端,则予以修补;否则行彻底瘢痕切除,不重建环状韧带,完全依赖尺骨畸形的矫正及其艮度的恢复来维持肱桡复位关系.术后2～3周长臂后托石膏田定;尺骨截骨端骨性愈合后,去除外同定架. 结果随访3～26个月,尺骨端全部愈合,肱桡关系好,肘内外翻稳定性伟、无疼痛.按照Morrey标准:好6例,中1例. 结论双球关节外固定架可有效维持尺骨截骨后的矫正性成角和延长长度.并于安置之后(甚至术后)仍可进行调整,以妥善稳定并维持手术获得的肱桡对应关系,还可早期进行功能训练,具有可操作和可调整优势.