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.     

环状韧带重建术治疗陈旧性孟氏骨折桡骨头脱位

我院自 1985年开始对成人陈旧性孟氏骨折中的桡骨头脱位 ,行环状韧带重建术 ,治疗桡骨头脱位 36例 ,取得了满意的临床效果。1　临床资料　　本组 36例 ,男 2 0例 ,女 16例 ;左侧 2 3例 ,右侧 13例。桡骨头肘前脱位者 32例 ,肘后脱位者 4例。合并桡神经迟发损伤者 3例。2　治疗方法在臂丛神经阻滞和气囊止血带下 ,取肘后外侧切口。自肱骨外髁上方 2ｃｍ ,沿肱三头肌外缘至鹰嘴外侧 ,向远侧沿尺骨背侧直至尺骨骨折及畸形处 ,长约 8ｃｍ。剥离肘后肌及尺侧腕屈肌。在剥离肘后肌时 ,应从尺骨附着处开始 ,暴露桡骨头及桡骨近端和尺骨上段桡侧面 ,…     

儿童孟氏骨折桡骨头脱位手术治疗52例临床分析

[目的]通过手术探讨儿童孟氏骨折桡骨头与环状韧带之间的病理关系,为预防桡骨头再脱位提供依据.[方法]对52例儿童孟氏骨折的桡骨头脱位行手术治疗,男37例,女15例,年龄3～13岁,平均8.1岁.右33例,左19例;骨折类型(Bado分类):Ⅰ型(伸直)型34例(65.4％),Ⅲ(内收)型18例(34.6％);尺骨骨折部位:尺骨近1/3骨折35例(67.3％),尺骨中1/3部骨折17例(32.7％).合并桡神经损伤6例.[结果]根据Mackay疗效评定标准.随访时间8个月～8年,平均27个月.52例全部为优.[结论]桡骨头的手术复位是一种简单、有效和安全的方法,能有效避免桡骨头的再脱位并提高儿童孟氏骨折的临床疗效.     

尺骨截骨环状韧带重建治疗儿童陈旧孟氏骨折

目的探讨对儿童陈旧孟氏骨折采用尺骨截骨延长环状韧带重建的治疗方法及疗效。方法对8例陈旧性孟氏骨折采用切开复位尺骨斜形截骨延长并同侧掌长肌腱重建环状韧带治疗。结果 8例均获得12~24个月随访。根据疗效标准:优5例,良2例,可1例。结论采用切开复位尺骨斜形截骨延长并同侧掌长肌腱重建环状韧带对儿童陈旧孟氏骨折是一种有效的治疗方法。     

儿童孟氏骨折脱位的治疗

作者自1979至1988年间收治儿童孟氏骨折55例,46例新鲜伤采用.手法整复外固定或手术治疗,9例陈旧性骨折脱位全部手术治疗.43例经1～2.5年的随访,肘关节伸屈和前臂旋转功能达优者36例(占83.7%),达良者4例(占9%).认为儿童孟氏骨折与成人不同,作者把此类损伤分成6型,Ⅰ、Ⅱ、Ⅲ豆型可采用手法复位治疗,而Ⅳ、Ⅴ、Ⅵ型手法复位困难,大多需手术治疗.     

儿童陈旧性孟氏骨折治疗进展

各种原因误诊、漏诊致使儿童孟氏骨折发展为陈旧性骨折,严重影响患儿前臂及肘关节生长发育.含肘关节的前臂影像学检查可避免孟氏骨折的误诊、漏诊,患肢电生理学检查有助于早期辅助诊断神经损伤.患儿骨折畸形愈合及前臂畸形发育影响前臂旋转功能及肘关节屈伸功能,脱位的桡骨头随年龄的增长而畸形发育,影响肘关节屈伸运动和前臂旋转功能.该文...     

尺骨截骨延长内固定联合环状韧带成形或重建手术治疗儿童陈旧性孟氏骨折的疗效分析

目的 探讨尺骨近端Z形截骨延长内固定联合环状韧带成形或重建手术治疗儿童陈旧性孟氏骨折的临床效果。方法 回顾性分析2015年1月至2018年1月我院行尺骨近端Z形截骨延长内固定联合环状韧带成形或重建手术治疗儿童陈旧性孟氏骨折28例患儿的临床资料,其中男18例,女10例;平均年龄为7.3岁（2~13岁）,受伤至手术平均时间为5.3个月（1~8个月）。合并轻度桡神经损伤症状者2例。记录并比较手术前后肘关节屈伸、前臂旋转活动范围。采用肘关节Mackay功能评分评价该术式对儿童陈旧性孟氏骨折的治疗效果。结果 28例患儿手术时间为（98.4±14.6）min,住院时间为（12.2±2.4）d,平均随访时间为9.6个月（8~15个月）,截骨临床愈合时间为（11.4±2.6）周;2例行环状韧带成形术的患儿,术后1个月复查时发现桡骨头脱位,再次行环状韧带重建术。末次随访Mackay功能评分优17例,良8例,可2例,差1例,优良率为89.3% 。术后未发生伤口感染。患儿术后肘关节屈伸活动范围为120.2°±6.7°,前臂旋前活动度为82.4°±5.3°,前臂旋后活动度为82.2°±5.6°,与术前的76.7°±10.1°、64.7°±10.2°、60.7°±8.7°比较,差异均有统计学意义（P均＜0.05）。结论 尺骨近端Z形截骨延长内固定联合环状韧带成形或重建手术治疗儿童陈旧性孟氏骨折可获得良好效果,是目前治疗儿童陈旧性孟氏骨折较为合理的手术方式。     

Monteggia type I equivalent lesion: diaphyseal ulna and proximal radius fracture with a posterior elbow dislocation in a child

A rare type I equivalent Monteggia lesion in a child, diaphyseal ulna and proximal radius fracture with a posterior elbow dislocation, is described, as well as the probable mechanism of injury. An excellent result was obtained with nonoperative treatment.     

Missed posterior shoulder dislocation with malunited proximal humerus fracture

Posterior dislocation of the shoulder may be missed or neglected at initial presentation especially in developing countries.We present a case of 40-year-old Indian man who had 3-month missed posterior dislocation of the right shoulder along with malunited fracture of the anatomical neck of the humerus.Open reduction and stabilization with modified McLaughlin procedure was performed.Rotational osteotomy of proximal humerus had to be performed as supplementary procedure to keep the humeral head stable in glenoid cavity during functional range of movements.The patient had excellent result of the shoulder at 3 years follow-up.     

Monteggia type I equivalent lesion: diaphyseal ulna and radius fractures with a posterior elbow dislocation in an adult

BACKGROUND: A rare type I Monteggia equivalent lesion with a posterior dislocation associated with a diaphyseal radius and ulna fracture in an adult is described. The probable mechanisms of injury are speculated to include flexion of the elbow and pronation of the forearm. METHODS AND RESULTS: Early reduction of the dislocation and rigid fixation of the fractures helped to achieve excellent results.     

Differential diagnosis of shoulder dislocation with special reference to posterior dislocation

Evaluation of a dislocated shoulder must classify the direction of dislocation and describe additional injuries as well as the recurrence rate. This is required in all types of dislocations by recording the case history in detail, and by examining the shoulder clinically as well as radiographically in two planes. Ultrasound and arthro-computer tomography are valid methods to demonstrate injuries of bony and ligamentous structures. They may therefore influence surgical treatment. In posterior dislocation of the shoulder quite often early diagnosis is missed. If this injury is suspected, careful clinical and radiographical evaluation is most important.     

The influence of lateral and anterior angulation of the proximal ulna on the treatment of a Monteggia fracture: an anatomical cadaver study

We have investigated the anatomy of the proximal part of the ulna to assess its influence on the use of plates in the management of fractures at this site. We examined 54 specimens from cadavers. The mean varus angulation in the proximal third was 17.5 degrees (11 degrees to 23 degrees ) and the mean anterior deviation 4.5 degrees (1 degrees to 14 degrees ). These variations must be considered when applying plates to the dorsal surface of the ulna for Monteggia-type fractures. A pre-operative radiograph of the contralateral elbow may also be of value.     

Neglected pediatric Monteggia fracture dislocation with persistent posterior interosseous nerve palsy: a case report

This is a rare case report of persistent PIN palsy following a case of neglected Monteggia fracture dislocation in a 7-year-old boy. The patient had presented with prominence around the elbow and inability to abduct the thumb, extend the thumb at interphalangeal joint, and inability to extend the fingers at the metacarpophalangeal joints. The index procedure of ulnar osteotomy and closed reduction of radial head did not yield satisfactory results; subsequently, patient underwent a second surgery for open reduction of radial and exploration of the PIN with simultaneous sural nerve grafting. To the best of our knowledge, this is the first case from India describing the use of sural nerve as a cable graft for neglected Monteggia fracture dislocation with nerve palsy.     

前后联合入路治疗儿童陈旧性孟氏骨折

[目的]探讨前后联合入路行关节切开复位、尺骨截骨术治疗儿童陈旧性孟氏骨折的方法及疗效。[方法]回顾性分析2010年11月~2015年1月收治的22例陈旧性孟氏骨折患儿资料。男15例,女7例,平均年龄7.5岁。伤后至手术时间除2例分别为3年、5年外,其余20例为1~12个月。患者X线片示桡骨头脱位,尺骨桡侧或掌侧弓形弯曲,伤后时间长者见桡骨过度生长。2例伴有桡神经深支损伤症状。所有患儿均采用经肘前Henry入路行肱桡关节切开、瘢痕彻底清除,有桡神经损伤者同时行神经探查松解;肘后沿尺骨嵴做纵切口,在尺骨鹰嘴下4~5 cm横行截骨,矫正尺骨畸形并反向成角、截骨端延长后予钢板固定。所有患儿均不行环状韧带重建。[结果]本组患儿随访12~59个月,平均15.4个月。根据Mackay功能评定标准,优19例,良2例,差1例。X线片示1例再脱位、2例半脱位,余复位稳定。术后肘关节屈伸功能较术前改善,差异具有统计学意义(P<0.05);手术前后前臂旋转功能的差别无统计学意义(P>0.05)。未出现血管神经损伤、异位骨化、尺桡骨骨性连接等并发症。2例桡神经深支损伤患儿3个月内恢复正常。[结论]前后联合入路治疗儿童陈旧性孟氏骨折具有术野显露好、术中操作简便、术后并发症少等优势。前入路允许直视下处理关节内病理改变,同时便于行桡神经探查松解,后入路有利于尺骨截骨矫形术。     

An unusual Monteggia equivalent type 1 lesion: Diaphyseal ulna and radius fractures with a posterior elbow dislocation in a child

In this report, we describe an extremely unusual Monteggia equivalent type 1 lesion in a 10-year-old boy following a fall from a height of 1 m. On the plain radiographs, our patient had a particular Monteggia equivalent type 1 injury associating a posterior elbow dislocation with diaphyseal radius and ulna fractures. The patient was treated by closed reduction technique. At six months of follow-up, the fractures were consolidated and the elbow was stable. To our knowledge, only 8 adult cases and one paediatric observation with similar lesions had been reported through medical literature. Therefore, the aim of our case report is to remind this rare entity and also to provide a comprehensive review of the literature related to this uncommon lesion.     

难复性肱骨近端骨折脱位的手术治疗

目的探讨难复性肱骨近端骨折脱位的合理手术治疗,以提高疗效。方法回顾性总结27例难复性肱骨近端骨折脱位病例资料。按NEER分型,两部分骨折脱位16例行切开复位T形钢板或三叶草钢板内固定,三部分骨折脱位11例行切开复位克氏针张力带内固定,术中采用可吸收缝线修补撕裂的肩袖及关节囊,术后早期功能锻炼。结果27例均获随访,时间12~59个月,平均29个月。疗效评价标准参照Constant-Murley评定方法,优良率达85.2%。结论对于难复性肱骨近端骨折脱位,保护局部血运甚为重要,术中采用间接复位技术、合理选择简单有效的内固定、充分保护软组织及修复肩袖等原则的应用对于术后功能恢复及预防相关并发症十分重要。