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。     

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。     

成人新鲜孟氏骨折桡骨小头的手术处理方法探讨

目的探讨手术治疗成人新鲜孟氏骨折术中桡骨小头的处理方法。方法回顾分析本院2000年1月至2009年12月间53例成人新鲜孟氏骨折术中桡骨小头处理方法与术后前臂功能恢复的关系。尺骨骨折均采用切开复位钢板螺钉坚强内固定,其中31例桡骨小头脱位采用闭合复位;22例采用切开复位、环状韧带修复或重建术。结果随访时间4~6个月,平均15.3个月,按B roberg和M orrey评分系统评定,闭合复位组满意率为90.3%,切开复位组满意率为86.4%。结论成人新鲜孟氏骨折术中应先行尺骨骨折切开复位坚强内固定,然后闭合复位桡骨小头,只有在闭合复位失败的情况下再选择切开复位、环状韧带修复或重建术。     

手术治疗小儿陈旧性孟氏骨折14例

目的探讨小儿陈旧性孟氏骨折的手术治疗方法和疗效。方法取肘外后方切口入路，从切口内切取筋膜条来重建环状韧带。对合并有桡神经损伤的患者同时作神经外膜切开减压松解术。结果本组14例除1例因受伤时间长达1年，以致桡骨小头向外后方脱位快速生长挤压了桡神经使该条神经变细，术后手指功给恢复差。其余13例采用上述手术方法均恢复正常功能。结论 小儿陈旧性孟氏骨折在切口内切取筋膜条来重建环状韧带稳定桡骨小头方法可靠。但桡神经损伤时间长是术后恢复不理想的重要原因。     

桡骨短缩截骨及韧带重建治疗儿童陈旧性孟氏骨折

目的探讨桡骨短缩截骨及肱三头肌腱膜重建环状韧带治疗儿童陈旧性孟氏骨折的手术方法及临床疗效。方法自2006年7月～2012年5月对12例儿童陈旧性孟氏骨折,均行桡骨短缩截骨并一期行桡骨小头复位、肱三头肌腱膜重建环状韧带,术后所有患儿均得到随访。结果术后平均随访时间18个月(6个月～3年),所有桡骨小头均维持良好复位,10例术后肘关节活动与术前一致,1例术后肘关节屈曲功能较术前减少10°,1例前臂旋后功能减少5°,1例术后浅表钉眼感染。结论采用桡骨短缩截骨及肱三头肌腱膜重建环状韧带治疗儿童陈旧性孟氏骨折的方法具有手术简单、并发症少、术后关节功能恢复快等优点,是一种可选择的方法。     

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。     

小儿孟氏骨折中环状韧带的损伤分类探讨

小儿孟氏骨折临床上较为多见 ,由于受伤机制不同 ,环状韧带有不同程度的损伤。关于小儿孟氏骨折诊断与治疗的论述较多 ,但未见对环状韧带的损伤程度进行具体的分类。我们通过对手法复位不满意的 98例该病患儿进行手术治疗 ,本文将手术中所见环状韧带的损伤情况分类列举如下 :1　损伤分类1.1　Ⅰ度损伤　即无断裂损伤 ,亦称牵拉损伤 ,此种损伤较轻 ,环状韧带只受到牵拉并未有断裂。因小儿桡骨小头尚未发育完全 ,头颈直径几乎相等 ,肘关节周围肌肉、韧带发育较差 ,关节囊亦较松弛 ,孟氏骨折时环状韧带滑越桡骨小头而嵌于桡骨小头与肱骨小头之…     

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。     

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。     

尺骨截骨矫形环状韧带重建治疗儿童陈旧孟氏骨折

目的探讨通过尺骨截骨结合环状韧带重建术治疗陈旧性儿童孟氏骨折的临床效果。方法本文回顾分析了自2010—2015年收治的儿童陈旧性孟氏骨折11例,其中男9例,女2例;年龄9~16岁,平均12.5岁。采用Boyd切口,显露肱桡关节、上尺桡关节及尺骨近端,对成角或短缩畸形的尺骨行截骨矫形,1/3管形钢板固定,切除嵌在肱桡关节或近端尺桡关节中残存的环状韧带和瘢痕组织,复位桡骨头后用克氏针固定,取前臂深筋膜绕桡骨颈重建环状韧带。如残存的环状韧带足够长可将其与纤维瘢痕视为一体合拢缠绕桡骨颈重建环状韧带。术后石膏外固定4~6周,拆除石膏,拔除克氏针后行功能锻练。结果随访10例,随访时间6~48个月。疗效评价:优8例,良1例,差l例,优良率达90%。肘关节由术前的屈25°~50°、伸5°~10°、旋前旋后5°~20°,改善为术后的屈90°~120°、伸0°~5°、旋前旋后75°~90°,功能改善明显。结论尺骨截骨矫正成角或短缩畸形,结合环状韧带重建治疗儿童陈旧孟氏骨折疗效满意。     

Treatment of Monteggia fracture in children

Described in this paper is a therapeutic concept by which to cope with Monteggia's fracture in childhood. It is based on experience obtained from 72 cases with injuries of that kind and their evaluation in a group study. Therapeutic approach to the individual case was determined by the following criteria: age of infant, localisation and shape of ulnar fracture, reducibility of capitulum radii, and accompanying injuries requiring treatment on the same arm. The need for surgical stabilisation of ulnar fracture was found to increase along with growing age of the affected child. High-stability anatomic reduction of the ulnar fracture proved to be a prerequisite for safe stabilisation of the radial capitulum. Close reduction has proved to be sufficient in many instances. Open reduction and internal fixation were found to be necessary in cases in which an ulnar fracture was irreducible or instable and/or a radial head was not reducible. Minimal osteosynthesis and plaster cast is considered to be an optional therapy for younger children, whereas ulnar stabilisation by means of plates is preferred for children in somewhat advanced age of childhood. The radial head may be fixed by trans-articular Kirschner's wire (WITT) or primary reconstruction of the annular ligament, using a strip of biceps or triceps tendon, or adaptation around the collum radii and ulna of the proximal radio-ulnar joint by means of a sling of Dexon or Vicryl suture.     

The Monteggia lesion in children. Fracture of the ulna and dislocation of the radial head

We reviewed the cases of fifteen children who were treated for a Monteggia injury. Transverse and metaphyseal fractures of the ulna were stable after closed reduction, but oblique fractures of the shaft redisplaced and required intramedullary pinning. Five patients who were seen late had open reduction and internal fixation of the fracture. Four of these children had reconstruction or repair of the annular ligament, with excellent results. But in the child in whom the ligament was not repaired the radius subluxated.     

新鲜儿童孟氏骨折治疗方法的选择

目的探讨新鲜儿童孟氏骨折不同治疗方法的选择。方法复习1995～2004年治疗的86例新鲜儿童孟氏骨折的临床资料,其中A组28例采用手法复位小夹板或石膏外固定;B组35例尺骨骨折采用开放复位内固定,桡骨头手法复位后肘部用护腕固定;C组23例采用开放复位内固定环状韧带修补术治疗,对三组的肘关节及前臂的功能进行分析,比较三组的疗效。结果随访时间8个月～9年,A组优15例,良8例,可3例,差2例;B组优25例,良8例,可2例,差0例;C组优14例,良6例,可2例,差1例。三组间比较,其差异无统计学意义(P>0．05)。结论对损伤程度不同的孟氏骨折应分别选用合适的治疗方式,其中桡骨头复位后护腕固定并配合尺骨骨折切开复位内固定适用于各种类型的孟氏骨折。     

Operative long-term results in delayed radius head dislocation in childhood

Only some cases and no long term follow-ups are reported in literature concerning the problem of delayed luxations of the radial head in children. 21 cases (19 acquired and 2 inherited) were treated in our hospital by operative procedure 12.5 months after the accident on the average. Disregarding one early and one late resection of the radial head we reconstructed the joint reposition and annular ligament plasty and if necessary correction osteotomy of the ulnar or shortening of the radius. Follow-up examination took place between 2 and 16 years after the operation, 7.9 years on the average. A reluxation was observed in 2 cases, a subluxation in 1 case. 2 patients showed a wrong axis and 4 patients signs of a beginning radio-humeral arthrosis, but most results were good or satisfactory. Therefore a reconstruction of a luxation of the radial head in children is recommended in delayed cases (sometimes in combination with a correction osteotomy of the ulna or radius) in contrast to other authors.     

Management of chronic posttraumatic radial head dislocation in children.

We describe a new procedure for the management of chronic posttraumatic radial head dislocation, which uses two drill holes in the proximal ulna. The holes are placed at the original attachments of the annular ligament and thereby allow repair of the annular ligament (frequently avulsed from one attachment and impinged within the joint) or reconstruction of the annular ligament with whatever tissue or material desired (triceps tendon is convenient). It secures the radial head in its normal position from any dislocated position. It also allows for osteotomy of any accompanying deformity of the ulna or radius. This operation developed gradually between 1967 and 1995 while we treated seven female patients. The average age at time of injury was 5 years 10 months (range, 3 years 4 months to 8 years 11 months). The interval between injury and operation averaged 30 months (range, 3 months to 7 years). The age at time of surgery averaged 8 years 4 months (range, 5 years 4 months to 13 years 5 months). The only criterion for surgery was a normal concave proximal radial articular surface. Follow-up averaged 48 months. At final follow-up, all patients were fully active and had no elbow pain or instability. Analysis of these cases suggests that the criteria for surgical repair should be based on two features: (a) normal concave radial head articular surface, and (b) normal shape and contour of the ulna and radius (deformity of either should be corrected by osteotomy). The age of the patient and duration of the dislocation are unimportant.     

Essex-Lopresti损伤的诊治分析

目的:总结Essex-Lopresti损伤的治疗经验,对比修复前臂骨间膜对近远期前臂功能的影响。方法:2005年1月至2013年12月收治24例Essex-Lopresti损伤患者,其中16例(A组)伴有尺骨干、桡骨干或尺桡骨干双骨折,先行尺骨或桡骨切开复位内固定,同时修复前臂骨间膜,然后再行桡骨小头复位固定和下尺桡关节固定或腕三角纤维复合体修复。8例(B组)不合并尺骨或桡骨骨折仅行桡骨小头复位固定和下尺桡关节固定或腕三角纤维复合体修复。分别于术后2周和2年按Cooney腕关节功能评分表(即改良Green和O’Brien腕关节评分)对腕关节功能进行评定,按Mayo肘关节功能评分表对肘关节功能进行评定。结果:术后2周时,腕关节功能评分A组可4例,差12例;B组可2例,差6例。肘关节评分A组良2例,可8例,差6例;B组良1例,可5例,差2例。术后2年时,A组腕关节功能评分良8例,可6例,差2例;B组良5例,可2例,差1例。肘关节评分A组良8例,可6例,差2例;B组良4例,可3例,差1例。两组术后2周和术后2年的疗效差异无统计学意义。结论:Essex-Lopresti损伤的治疗关键在于恢复尺桡骨的长度和腕、肘关节的动态稳定性,是否修复前臂骨间膜对前臂近远期功能影响无明显区别。     

Outcome Following Acute Primary Distal Ulna Resection for Comminuted Distal Ulna Fractures at the Time of Operative Fixation of Unstable Fractures of the Distal Radius

Optimal acute management of the highly comminuted distal ulna head/neck fracture sustained in conjunction with an unstable distal radius fracture requiring operative fixation is not well established. The purpose of the present study was to determine the clinical, radiographic, and functional outcomes following acute primary distal ulna resection for comminuted distal ulna fractures performed in conjunction with the operative fixation of unstable distal radius fractures. Between 2000 and 2007, 11 consecutive patients, mean age 62 years (range, 30–75) were treated for concomitant closed, comminuted, unstable fractures of the distal radius and ulna metaphysis. All 11 patients underwent distal ulna resection through a separate dorsal ulnar incision with ECU tenodesis following surgical fixation of the distal radius fracture. According to the Q modifier of the Comprehensive Classification of Fractures, there were six comminuted fractures of the ulnar neck (Q3) and five fractures of the head/neck (Q5). Operative fixation of the distal radius fracture included volar plate fixation in four patients and spanning external fixation with supplemental percutaneous Kirschner wires in seven patients. At a mean of 42 months (range, 18–61 months) postoperatively, clinical, radiographic, and wrist-specific functional outcome with the modified Gartland and Werley wrist score were evaluated. At latest follow-up, mean wrist range of motion measured 53° flexion (range, 35–60°), 52° extension (range, 30–60°), 81° pronation (range, 75–85°), and 77° supination (range, 70–85°). Mean grip strength measured 90% of the contralateral, uninjured extremity (range, 50–133%). No patient had distal ulna instability. Final radiographic assessment demonstrated restoration of distal radius articular alignment. According to the system of Gartland and Werley as modified by Sarmiento, there were seven excellent and four good results. No patient has required a secondary surgical procedure. Acute primary distal ulna resection yields satisfactory clinical, radiographic, and functional results in appropriately selected patients and represents a reliable alternative to open reduction and internal fixation when anatomic restoration of the distal ulna/sigmoid notch cannot be achieved. Primary distal ulna resection with distal radius fracture fixation may help avoid secondary procedures related to distal ulna fixation or symptomatic post-traumatic distal radioulnar joint arthrosis.     

The malunited juvenile fracture--Monteggia defect]

Late reconstruction after neglected Monteggia lesions in children is discussed. On the basis of the literature (20 cases) and 2 personal cases it is deduced that open reduction of the radial head should be combined with osteotomy of the ulna according to the pathophysiology of the lesion. Details of the operative procedure are given. Reconstruction of the annular ligament is the least important part. Reconstruction is indicated in children under the age of 10-12 years even if the dislocation has been present for years. Unfavorable conditions for operative reconstruction are long-lasting dislocations in older children, deformation of the radial head, and imminent skeletal maturity.     

超声在儿童尺桡骨骨折闭合复位弹性髓内钉固定术中的应用

目的探讨超声在儿童尺桡骨骨折闭合复位弹性髓内钉固定术中的应用效果。方法对30例新鲜闭合尺桡骨骨折患儿术中在超声引导下进行骨折闭合复位弹性髓内钉固定,记录术后患肢功能及并发症。结果30例均在超声引导下成功闭合复位,髓内钉通过骨折断端时未造成血管、神经损伤。患儿均获得随访,时间6~9个月。骨折均达到骨性愈合,未发现内固定移位、断裂及骨折畸形愈合等情况。末次随访时,根据Berton评定标准评价疗效:优27例,良3例。结论术中在超声引导下可以实现儿童尺桡骨骨折闭合复位内固定,且具有创伤小、辐射少的优点。     

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.