成人尺骨近端向后孟氏损伤的诊断与治疗

目的 探讨成人尺骨近端向后孟氏损伤的诊断、鉴别诊断及治疗策略.方法 2004年4月至2007年12月共手术治疗16例成人尺骨近端向后孟氏损伤患者,其中对13例患者获得随访,随访时间12～58个月,平均28个月.手术均采用肘关节后正中入路.术中尽量对桡骨头骨折和冠状突骨折进行复位和固定.对尺骨近端的固定,7例采用单纯钢板,2例钢板加克氏针,3例钢板加克氏针张力带,1例克氏针张力带加螺钉.结果 末次随访时均无明显疼痛及肘关节不稳定.患肢肘关节伸屈活动范围平均为100°(0°～145°),前臂旋转活动范围平均为119°(0°～170°).Mayo肘关节功能评分(MEPS评分)平均为93.1分(67～100分),优良率92.3%.Broberg-Morrey评分平均为88.8分(53～100分),优良率76.9%.结论 对尺骨近端向后孟氏损伤要注意正确的诊断与鉴别诊断.手术治疗的关键要重建尺骨近端长度和对线,尽量对其进行解剖复位并牢固固定.

Posterior monteggia fracture-dislocations of proximal ulna

Objectives To discuss the diagnosis and differential diagnosis, and to establish an effective protocol to treat the posterior Monteggia fracture-dislocations of proximal ulna in adult according to our experience. Methods Between April 2004 and December 2007, 16 patients with posterior Monteggia fracture-dislocations were treated surgically, 13 were followed up at a mean of 28 months (range, 12-58 months). All the operations were through the posterior midline approach. The fractures of radial head and coronoid process were reduced and fixed, if possible. The proximal ulna fractures were fixed with a single plate in 7cases, plate combined with K-wires in 2, plate combined with K-wires tension band in 3, and K-wires tension band combined with screws in 1. Results No elbow was painful or unstable at the last follow up examination. They had an average of 100°(range, 0° to 145°) of flexion-extension of elbow. The average motion of forearm rotation was 119°(range, 0° to 170°). The mean Mayo Elbow Performance Score (MEPS)was 93. 1 points(67-100 points), excellent and good results were achieved in 92.3%. The mean system of Broberg and Morrey score was 88.8 points (53-100 points), excellent and good results were achieved in 76.9%. Conclusions Attention should be payed to the diagnosis and differential diagnosis of the posterior Monteggia fracture-dislocation of proximal ulna. Anatomically reduction and stable fixation of proximal ulna is the keystone for the surgical treatment.