钢丝套环治疗需修复环状韧带的成年新鲜 Monteggia 骨折的初步报告

目的 探讨钢丝套环法治疗需修复环状韧带的成年新鲜Monteggia骨折的初步疗效.方法 2006年5月至2008年3月共收治15例需修补环状韧带的成年新鲜Monteggia骨折患者,其中男9例,女6例;年龄19～46岁,平均29.8岁.骨折按Bado分型:Ⅰ型6例,Ⅱ型4例,Ⅲ型5例.均采用尺骨骨折切开复位钢板内固定,桡骨头切开复位后用直径0.8 mm钢丝套住桡骨颈固定于尺骨近端,修补环状韧带,术后48 h开始肘关节功能锻炼,3周去除内固定钢丝. 结果 15例患者术后获得8～11个月(平均9.5个月)随访.3周取出钢丝未见钢丝断裂患者,12～16个月(平均13.3个月)取出尺骨固定钢板.参照Broberg和Morrey评分标准:优11例,良2例,可2例,优良率为86.7%.1例肘关节有轻度疼痛,2例有中度疼痛.1例桡神经深支损伤患者于术后3个月恢复伸指、伸拇功能.未见尺骨骨不连和桡骨头缺血性坏死等并发症发生. 结论 钢丝套环法是治疗需修补环状韧带的成年新鲜Monteggia骨折的较理想方法.

Treatment of fresh Monteggia fracture with steel-wire loop in adults whose annular ligament needs repairing

Objective To assess the treatment of fresh Monteggia fracture with a steel-wire loop for adults whose annular ligament needs repairing. Methods From May 2006 to March 2008, we treated 15 adult patients with fresh Monteggia fracture whose annular ligament needed repairing with a steel-wire loop. A retrospective study was performed for the 15 cases, including 9 males and 6 females. Their ages ranged from 19 to 46 years. According to the Bado classification system, there were 6 cases of type Ⅰ, 4 type Ⅱ, 5 type Ⅲ. The ulnar fractures were treated with open reduction and compression plate fixation. Next, radial head dislocations were reduced openly and the reduced heads were hitched to the proximal end of the ulna with a steel-wire loop of 0.8 mm in diameter around the radial neck. Last, the broken annular ligaments were repaired. The elbow functional trainings were carried out 48 hours after operation and the steel-wire was removed 3 weeks postoperatively. Results The patients were followed up for 8 to 11 months (mean,9. 5 months). The functional recovery evaluated by Broberg and Morrey evaluation system showed excellent results in 11 patients, good in 2, fair in 2 and poor in 0. The excellent to good rate was 86. 7%.Conclusion The steel-wire loop treatment is a good strategy for adults with fresh Monteggia fracture whose annular ligament needs repairing.