儿童陈旧性孟氏骨折的手术治疗

目的:通过研究火器伤所致骨折患者的治疗及预后情况,探讨如何选择合理方法对其进行及时有效的治疗。方法:对25例火器伤所致骨折患者的治疗及预后情况进行回顾性总结分析,其中男18例,女7例;平均年龄36.2岁。骨折的部位为股骨骨折9例,胫骨骨折7例,肱骨骨折2例,骨盆骨折2例,锁骨骨折1例,椎体骨折1例,尺、桡骨骨折1例,髋关节骨折1例与膝关节损伤1例。骨折类型为未移位1例,移位2例,粉碎性10例,粉碎且移位6例,骨缺损6例。19例接受了骨科手术治疗,其他6例接受了清创治疗。10例采用外固定架固定,7例行内固定,4例行管形石膏固定,2例骨盆与髋臼骨折采用牵引治疗,2例锁骨骨折应用锁骨带治疗。结果:25例患者获得了平均4.2年的随访,18例骨折Ⅰ期愈合,6例需后期手术促进骨折愈合,1例截肢。有5例需要后期手术覆盖创面。大的并发症包括2例骨不连,4例延迟愈合,3例周围神经功能受损。结论:骨折固定方法的选择与骨移植是治疗火器伤所致的骨折与骨缺损的一项很有效的方法。

Surgical treatment of obsolete Monteggia fractures in children

Objective:To study therapeutic effects and prognosis for fractures caused by firearms,so as to find better methods to treat them.Methods:Among 25 patients involved in the retrospective study,18 patients were male and 7 patients were female,with an average age of 36.2 years.The positions of fracture were as follows:9 patients in the femur,7 patients in the tibia,2 patients in the humerus,2 patients in the pelvis,1 patient in the clavicle,1 patient in the vertebra,1 patient in the radius and ulna,1 patient in the hip joint and 1 patient in the knee joint.There were undisplaced fractures in 1 patient,displaced fractures in 2 patients,comminuted fractures in 10 patients,comminuted and displaced fractures in 6 patients,and bony defects in 6 patients.Nineteen patients underwent operation and other 6 patients accepted debridement.As to fixation,10 patients were treated with external fixator,7 patients were treated with internal fixation,4 patients with plaster,2 patients with pelvis and acetabular fractures were treated with traction,and 2 patients with fracture of clavicle were treated with clavicle band.Results:All the patients were followed-up for an average of 4.2 years.Eighteen patients had fracture healed at the first stage.Late-stage surgery was necessary to achieve soft-tissue coverage in 5 cases and to achieve union in 6 cases.One patient underwent amputation.The major complications included amputation in 1 patient,non-union in 2,delayed union in 4,and loss of peripheral nerve functions in 3.Conclusion:Choice of fixation of fracture and bone graft appears to be an efficacious technique in the treatment of fractures and bone defects associated with firearm injuries.