尺骨近端截骨治疗少年陈旧性单纯桡骨头脱位

目的评估采用尺骨近端截骨治疗少年陈旧性单纯桡骨头脱位的临床疗效。方法回顾性研究了采用尺骨近端截骨治疗陈旧性单纯桡骨头脱位的6例患者,手术时的年龄从7～12岁,从受伤到接受手术治疗的时间间隔为6个月～4年,平均为[(19．3±16．5)个月,x±s,下同],其中2例患者同时缝合了环状韧带,1例患者进行了桡侧侧副韧带的重建。重点分析了术后功能恢复情况和术前、术后的影像学改变。结果本组6例术后随访时间平均为(16．5±8．7)个月。所有患者截骨部位均达骨性愈合,无异位骨化或其他较为严重的并发症,也无肘关节疼痛和桡骨头再脱位。肘关节屈伸活动度为(140．0±7．1)°,前臂旋转活动度为(129．0±18．4)°,患侧握力占健侧握力的百分比为(96．9±3．5)％。术后影像学提示随着随访时间的延长,尺骨的再塑形非常明显,表现为截骨所致的向后成角逐渐圆滑,最终成角消失,以及损伤所致的“尺骨弓征”逐渐纠正。结论对于少年陈旧性单纯桡骨头脱位如果无明显桡骨头畸形,采用尺骨近端截骨治疗可以取得较为满意的疗效。     

改良Ilizarov技术治疗成人桡骨头前脱位

目的：探讨应用改良Ilizarov技术治疗成人桡骨头前脱位的疗效。方法对6例成人桡骨头前脱位,按设计将改良后的三组 Ilizarov 环安放在患肢前臂背侧,距尺骨鹰嘴5.0 cm处行尺骨横行截骨,然后沿其纵轴延长,达适宜长度后,再将尺骨向后成角延长,桡骨头即缓慢复位。结果术后平均随访8个月（3～10个月）,桡骨头复位良好稳定;肘关节伸屈活动基本正常,前臂旋前达90＆#176;,旋后较术前有明显改善,平均55＆#176;;尺骨延长部位全部骨性愈合。其中1例出现个别钉道表浅感染,经处理痊愈。结论应用改良Ilizarov技术治疗成人桡骨头前脱位操作简单,创伤小,不干扰肱桡关节,改良环固定牢靠,复位桡骨头稳定而且肘关节伸屈和前臂旋转功能恢复满意,是临床值得推广的治疗方法。     

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。     

尺骨成角截骨治疗儿童陈旧性孟氏骨折

尺骨成角截骨治疗陈旧性孟氏骨折对恢复肘关节正常解剖关系及功能 ,增加肘关节稳定和防止晚期桡神经损伤起到了积极的治疗作用。我院自 1995年 1月～ 2 0 0 2年 7月采用尺骨成角截骨成功治疗 3月例陈旧性孟氏骨折患儿 ,报告如下。1　临床资料1 1　一般资料　男 11例 ,女 6例。年龄 5～ 14岁 ,平均 8岁。右侧 12例 ,左侧 5例 ;就诊时间从伤后 2 2d～ 6年 6个月 ,平均 11 9个月。其中早期误诊 4例 ,漏诊 3例 ,急性期非手术治疗失败 4例 ,手术治疗失败 6例。体格检查 :肘关节前、后方或外侧可触及脱位的桡骨头 ,肘关节屈伸活动正常 ,前臂平均旋…     

肘关节造影在儿童陈旧性桡骨头脱位治疗中的应用价值

目的探讨和分析肘关节造影在儿童陈旧性桡骨头脱位治疗中的应用价值。方法 2014年1月至2017年1月,共收治15例陈旧性桡骨头脱位儿童,男11例,女4例;年龄3~11岁,平均9岁。术中行肘关节造影来观察桡骨头与关节囊的位置。通过手术打开关节囊,来证实桡骨头的脱位性质。采用尺骨近端截骨复位桡骨头,钢板螺钉固定截骨断端治疗。结果通过肘关节造影,12例桡骨头位于关节囊内,3例桡骨头位于关节囊外。打开关节囊,先天性桡骨头脱位的桡骨头与肱骨小头之间没有瘢痕组织,桡骨头凹浅平;而创伤性脱位的桡骨头与肱骨小头之间有明显的瘢痕组织,桡骨头凹明显。其中8例先天性桡骨头脱位病例桡骨头均位于关节囊内。7例创伤性脱位中4例桡骨头位于关节囊内,3例位于关节囊外。经过9个月至3年8个月,平均2年4个月的随访,术后没有桡骨头再脱位或半脱位情况发生。结论肘关节造影对于鉴别诊断桡骨头脱位有一定的辅助价值。尺骨近端截骨是治疗儿童陈旧性桡骨头脱位的一种有效方式。     

应用Ilizarov技术微创治疗儿童陈旧性孟氏骨折的临床研究

[目的]探讨应用Ilizarov外固定架治疗儿童陈旧性孟氏骨折的疗效。[方法]2012年3月~2013年10月应用改良Ilizarov外固定架微创治疗儿童陈旧性孟氏骨折13例,年龄2~13岁,平均7.6岁;在尺骨适宜部位以直径2.5 mm螺纹半针固定3组半环形固定器,距尺骨鹰嘴3~5 cm处作尺骨横断截骨,术后1周沿尺骨长轴行纵向延长,每日1 mm,分6次完成,骨延长至肱桡关节间隙达5 mm时,停止尺骨纵向延长,依靠Ilizarov外固定器三组铰链不等距延长,使尺骨向与桡骨头脱位相反方向成角,桡骨头即缓慢复位。[结果]全部患儿均获随访,尺骨截骨处平均3.2个月骨性愈合,桡骨头复位稳定;肘关节伸屈和前臂旋转功能均有显著改善,肘关节伸屈在0°~130°,前臂旋前45°~85°,前臂旋后60°~90°。根据Mackay功能评定标准:优11例,良2例。[结论]应用Ilizarov技术微创治疗儿童陈旧性孟氏骨折有以下优点:(1)创伤小,尺骨背侧仅有1~1.5 cm切口;(2)操作方便,全部螺纹半针均在皮下可触及的尺骨上固定;(3)桡骨头复位稳定,随诊患儿无1例复发;(4)肘关节伸屈和前臂旋转功能恢复满意。本疗法值得临床推广应用。     

尺骨截骨治疗儿童陈旧性孟氏骨折

目的探讨尺骨截骨手术治疗陈旧性儿童孟氏骨折的疗效。方法对28例患儿采取尺骨截骨固定桡骨小头复位,同时行环状韧带重建,其中3例行桡骨中段缩短截骨固定。结果28例均得到随访,时间6个月～8年。肘关节功能：优20例,良8例。4例合并桡神经损伤患儿完全得到恢复。结论尺骨截骨手术是治疗儿童陈旧性孟氏骨折良好术式。     

切开探查、尺骨截骨、环状韧带复位治疗儿童陈旧性孟氏骨折的疗效分析

目的探讨切开探查、尺骨截骨、环状韧带复位(三合一手术)治疗儿童陈旧性孟氏骨折的疗效。方法回顾性分析2017年6月至2021年9月天津大学天津医院小儿骨科收治的35例儿童陈旧性孟氏骨折患者资料。男22例, 女13例;左侧19例, 右侧16例;年龄(6.8±2.5)岁;桡骨头向前侧脱位30例, 向前外侧脱位5例。受伤至手术时间为(17.9±9.9)个月。所有患者均采用三合一手术治疗。测量并比较所有患者术后12个月肘关节屈伸范围、前臂旋转范围及肘关节特种外科医院(HSS)评分。同时记录并发症发生情况。结果所有患儿术后均获12个月随访, 术后1.5～4.0个月尺骨截骨端达到骨性愈合。术后12个月肘关节伸直活动度(-1.0°±5.9°)、屈曲活动度(128.5°±4.9°)均较术前(-9.3°±18.0°、108.4°±17.3°)显著改善, 差异均有统计学意义(P<0.05)。术后12个月前臂旋前活动度(61.5°±19.4°)较术前(72.7°±22.4°)受限, 差异有统计学意义(P<0.05);术后12个月前臂旋后活动度(86.7°±4.5°)与术前(81.0°±17.4°)...     

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。     

Monteggia骨折150例报告（附文献复习）

小儿高位Ｍｏｎｔｅｇｇｉａ骨折亦称Ｈｕｍｅ骨折。１９８６～１９９１作者采用手法复位、纸塑瓦楞夹板固定法治疗１５０例，平均临床愈合时间４５ｄ。８７例获得随访，平均随访时间４１５月。结果优良率９３８％。作者提出扩大Ｈｕｍｅ骨折的概念范围为：小儿尺骨近段或鹰嘴骨折，合并桡骨头各方向的脱位或半脱位。作者对临床资料分析认为：（１）先整复尺骨骨折，再整复桡骨头，可使变异了的近尺桡间隙得到纠正，为桡骨头的复位创造条件。（２）Ｘ线检查采用前臂中立位投照法和“划点法”，可排除前臂旋转及伤后畸形的干扰，避免漏诊和误诊。（３）前臂中立位固定、置肘关节极度屈曲位，是维持桡骨头稳定的关键。同时还可以预防继发性桡神经损伤     

修复前关节囊在"肘关节恐怖三联征"手术治疗中的疗效观察

目的探讨修复前关节囊在"肘关节恐怖三联征"手术治疗中的疗效。 方法自2015年5月至2017年12月苏州大学附属瑞华医院手外科采用手术修复前关节囊治疗8例肘关节恐怖三联征患者，根据影像学评价观察骨折愈合情况。采用Mayo肘关节功能评分评估肘关节功能情况。 结果所有患者均获得6~36个月随访，平均18个月。切口均Ⅰ期愈合。骨折均愈合，时间为8~12周，平均10周。根据术后6个月随访，肘关节屈位0°~15°，伸位130°~145°，平均活动范围为115°，旋前60°~90°，旋后40°~70°，平均旋转范围120°。术后无骨折块移位、内固定失效、锁定接骨板螺钉松动或断裂、切口感染、异位骨化等并发症发生。肘关节功能恢复良好，采用Mayo肘关节功能评分：优6例，良2例。 结论在肘关节恐怖三联征时修复前关节囊，恢复肘关节的稳定性，并发症少，骨折愈合快，及早配合正规的康复锻炼，肘关节功能恢复好，疗效确切。     

平行与垂直双钢板内固定治疗AO-C型肱骨远端骨折的疗效比较

目的比较平行双钢板及垂直双钢板内固定治疗AO-C型肱骨远端骨折的临床疗效。方法回顾性分析自2011-03—2016-01诊治的32例AO-C型肱骨远端骨折,采用平行双钢板内固定治疗17例(平行组),采用垂直双钢板内固定治疗15例(垂直组)。比较2组术后6个月VAS评分,末次随时肘关节活动屈伸范围、前臂旋转范围及肘关节功能Mayo评分,术后并发症发生情况。结果 32例均获得随访6~12个月,平均10.5个月。平行组1例出现尺神经损伤,予以甲钴胺片营养神经治疗4个月后神经症状恢复;垂直组1例出现轻度异位骨化,患肘屈伸约92°,旋转102°,活动明显受限;平行组、垂直组各2例出现肘关节活动明显受限,需二期行肘关节松解术。2组并发症比较差异无统计学意义(P0.05)。平行组术后6个月VAS评分为(0.59±0.71)分,垂直组为(0.60±0.63)分,2组差异无统计学意义(P0.05)。2组患侧肘关节屈伸活动度、前臂旋转活动度及肘关节功能Mayo评分比较差异均无统计学意义(P0.05)。结论垂直双钢板或平行双钢板内固定治疗AO-C型肱骨远端骨折均可取得良好疗效,应根据骨折的形态、软组织损伤程度、患者一般情况选择适当的内固定方式。     

Surgical treatment of missed Monteggia lesions in children

Purpose The treatment of an unrecognized Monteggia lesion continues to pose a therapeutic challenge, as evidenced by the variety of surgical techniques described. Moreover, there are high complication and redislocation rates following surgery. This report concerns a surgical technique to reduce a chronic dislocation of the radial head utilizing an ulnar osteotomy and internal fixation. Methods Six consecutive cases of missed Monteggia lesions were treated in our institution between August 2001 and September 2003. Patient mean age was 6.5 (range 4–8) years, and the mean interval between injury and surgical procedure was 17 (range 1–49) months. Surgery consisted of an ulnar osteotomy with angulation and lengthening, bone grafting at the osteotomy site, and internal fixation. Open reduction of the radial head, repair or reconstruction of the annular ligament or temporary fixation of the radial head with a transarticular wire was not undertaken. Cast immobilization with the forearm in neutral rotation was maintained for 2 weeks. Results There was one case of nonunion. At an average follow-up of 3 (range 1.5–4.4) years, all patients had regained painless function of the forearm, good range of elbow and forearm motion, and maintenance of the radial head reduction. Conclusions Both angulation and elongation of the ulna are required to allow for reduction of the radial head. We do not see any indication for procedures directed at the radio-capitellar joint.     

阔筋膜重建环状韧带结合内固定治疗孟氏骨折

目的:探讨阔筋膜重建环状韧带结合内固定治疗孟氏骨折的临床疗效。方法 :2014年12月至2016年10月收治孟氏骨折30例,其中男18例,女12例;年龄6~50岁,平均34.6岁;30例均行阔筋膜重建环状韧带结合内固定手术。根据Mackay疗效评定标准评价肘关节功能。结果:30例获得平均12.5个月随访,无桡骨头再发脱位,尺骨重建钢板内固定全部骨性愈合。根据Mackay疗效评定标准评价,优23例,良5例,差2例。4例出现轻度肘关节疼痛,无腕关节疼痛病例。功能恢复以前臂活动最快、最满意。8例伸肘功能障碍,平均受限9.1°,6例合并桡神经迟发损伤者术后半年全部恢复。结论:对于孟氏骨折,阔筋膜重建环状韧带结合内固定手术能有效恢复前臂旋转功能,近期疗效满意,远期效果有待进一步观察。     

尺骨干骺端续连症不同手术方法的疗效观察

目的:探讨尺骨骨软骨瘤切除、尺骨微创截骨、外固定尺骨延长术治疗尺骨干骺端续连症前臂畸形治疗效果和安全性.方法:自2005年8月至2013年12月,20例尺骨干骺端续连症患者,男15例,女5例;年龄7～13(10.00±2.34)岁;病程6～11(8.10±1.52)个月;临床表现为患侧前臂短缩并向尺侧弯曲畸形.采用尺骨...     

Radial head dislocation with ulnar plastic deformation in children: an osteotomy within the middle third of the ulna

This retrospective study includes 6 patients (average age, 8.7 years) with a dislocation of the radial head and ulnar plastic deformation. All were Monteggia fractures, Bado type I equivalents. The maximum ulnar bow was near the midulna. Five patients underwent an ulnar osteotomy, with elongation and reduction of the angulation within the middle third of the ulna, and open reduction of the radial head. One patient underwent an ulnar osteotomy with only elongation. The osteotomy sites were stabilized by a plate and screws or Kirschner wires. Mean follow-up was 3.4 years. Postoperatively, the average elbow range of motion was extension to 0 degrees, flexion to 138 degrees, forearm supination to 90 degrees, and forearm pronation to 88 degrees. Results in all patients were rated as excellent. One nonunion occurred. An osteotomy performed within the middle third of the ulna, combined with open reduction of the radial head, resulted in excellent clinical outcomes.     

A figure-eight suture loop with Kirschner wires for fixation of anteromedial coronoid process fractures: A case series

PurposeSufficient fixation of an anterior or anteromedial facet fracture of the coronoid process in fracture-dislocation of elbow is important to maintain joint stability. The purpose of this study was to report our experience with 11 patients who were managed with an original fixation technique using a “figure-eight” suture loop.MethodsFrom February 2010 to March 2011, 11 cases with a fracture of the anterior or anteromedial facet of the coronoid process were treated by coronoid fixation using a figure-eight suture loop. For cases with comminuted fractures, to prevent a suture from sliding into the fracture line, a 3- or 4-hole phalanx plate was enclosed in the suture loop to compress multiple fragments. Accompanying injuries, such as a radial head fracture or olecranon fracture, were fixed with repair of lateral collateral ligament injuries.ResultsOn final evaluations at an average of 18 months after injury, the mean elbow arc of motion was 125.5° and the mean forearm rotation arc of 124.1°. All fractures were united with an average postoperative score according to the Mayo Elbow Performance Index of 91 points. All patients achieved satisfactory scores (seven excellent, four good). All 11 fractures were united at final follow-up with no joint incongruity, dislocation, or subluxation of the injured elbow.ConclusionsThe figure-eight suture loop technique is an easy and effective technique to fix anterior or anteromedial facet fractures of the coronoid process.     

Surgical treatment for chronic radial head dislocation

BACKGROUND: The treatment of chronic radial head dislocation remains controversial. High rates of redislocation and complications have been reported after surgery. In our view, correction of malalignment with ulnar osteotomy is the key to a good surgical result. METHODS: Since 1975, twenty-two patients were treated surgically for chronic radial head dislocation at our hospital. The procedure consisted of open reduction of a dislocated radial head followed by radial and/or ulnar osteotomy, with or without reconstruction of the annular ligament or by reconstruction of the annular ligament alone. The ages of the patients ranged from four to twenty years. In 1991, we modified the surgical technique by performing an oblique ulnar osteotomy with angulation and elongation and rigid plate fixation. Bone-grafting at the osteotomy site was also performed if necessary. A cast was applied with the forearm in neutral rotation and was worn for two to four weeks. Nine patients were treated with this modified technique. RESULTS: The mean interval between the initial injury and the reconstructive surgery was ten months. There were no serious surgical complications. Of the thirteen patients treated before 1991, four had a good reduction and seven had redislocation. Seven patients had restricted forearm rotation postoperatively. Of the nine patients treated with the modified osteotomy since 1991, seven had a good reduction. Two patients, who had had slight radial head deformity preoperatively, had subluxation postoperatively. Two patients had restricted forearm rotation. CONCLUSIONS: Since we modified our technique for ulnar osteotomy, good reduction of the radial head has been achieved without causing serious contracture. Both angulation and elongation of the ulna are required to allow the radial head to reduce.