小儿孟氏骨折脱位扣眼畸形的病理认识以及环状韧带重建术的探讨

目的 对小儿盂氏骨折脱位及陈旧性盂氏骨折的传统治疗方法、创伤病理解剖、治疗结果及发生漏、误诊、误治的病例进行研究,以找到解决问题的方法,提高疗效。方法 对170例盂氏骨折脱位患儿的致病原因、治疗方法、术中所见、手术方式以及治疗效果等进行研究、分析。结果 83例中,优59例,良15例,一般9例,差5例,结论 （1）盂氏骨折脱位的定义应为：尺骨干骨折合并桡-肱及桡-尺脱位,合并/或不合并桡骨上1/3骨折、桡骨颈骨折、桡骨头骨折脱位;（2）尺骨鹰嘴骨折合并肘关节脱位不应诊断为盂氏骨折;（3）提出“超伸直型”盂氏骨折的概念;（4）尺骨骨折的稳妥治疗及坚强内固定是治疗盂氏骨折的关键;（5）桡骨颈骨折既要对位好,更要对线好,以免以后发生旋转障碍;（6）急诊患儿可行环状带修补术及关节囊紧缩术,晚期患儿应行关节囊紧缩术,不主张行环状韧带重建术。

Pathology of buttonhole deformity of Monteggia fracture-dislocation and suitability of reconstructive surgery of anular ligaments

Objective To establish better treatment for Monteggia fracture by studying the traditional management, traumatic anatomy, treatment efficacy, and misdiagnosed cases of Monteggia fracture dislocation and old Monteggia fracture in children. Methods 170 children with Monteggia fracture dislocation were examined in terms of causes, treatment, intraoperative findings, operational techniques and efficacy etc. Results Of 83 cases treated, the results were excellent in 59, good in 15, fair in 9 and poor in 5. Conclusions (1) The Monteggia fracture dislocation should be defined as fracture of ulna combined with radiohumeral and radioulnar dislocation, with or without dislocation of fracture of upper one third, neck of radius, and head of radius. (2) The Monteggia fracture should not cover fracture of ulnar olecranon combined with elbow dislocation. (3) A "super straight type"Monteggie fracture concept was proposed. (4) The careful treatment of fracture of ulna and firm internal fixation are the keys of treatment of Monteggia fracture. (5) For the treatment of fracture of neck of radius, linear as well as positional alignment should be achieved to avoid later development of rotation disorder. (6) For emergency cases of juvenile Monteggia fracture, repair of anular ligaments can be performed and reefing of joint capsule can be done for late stage cases. Reconstruction of anular ligaments is not recommended.