儿童孟氏骨折的手术治疗

目的探讨儿童孟氏骨折的手术治疗方法及疗效.方法1995年7月～2004年6月,收治31例儿童孟氏骨折,合并桡神经深支损伤7例,尺神经损伤1例,受伤时间1天～12个月,平均40天,所有病例均接受手术治疗,进行尺骨解剖复位、坚强内固定、环状韧带修复重建并以克氏针固定肱桡关节,受累神经探查减压.结果术后石膏托固定6周后,拔除克氏针,开始进行肘关节及前臂功能锻炼.所有病例均获随访6个月至8年,平均4.2年,按李汉民等所制定标准进行肘关节功能评定,优25例,良4例,可1例,差1例,优良率93.6%.结论儿童孟氏骨折应积极尽早进行手术治疗,行肘关节解剖复位、坚强内固定、环状韧带重建修复并固定肘桡关节,受累神经探查减压、早期功能锻炼,可获得满意的疗效.

Surgical treatment for Monteggia's fracture in children

Objective To investigate the operative treatment and clinic efficacy for Monteggia's fracture in children. Methods From July,1995 to June,2004,31 Children with Monteggia's fractures complicated with the involvement of profundus rami of radial nerve in 7,of ulnar nerve in1,and the average posttraumatic time of 40 days(range,1 day to 12 months),were treated in an operative procedure,which includes anatomic reduction of ulnar and rigid internal fixation,reduction and fixation with kirsner wire of the radiao-humeral joint,repairation or reconstruction of the anular ligament,and exploration and decompression of the involved nerves. Results After six weeks of plaster postoperatively,Kirsner wire of the radiao-humeral joint was removed and functional practice of the elbow was commenced. All patients were available in the final follow-up with a mean of 4.2 years. According to the LiHan-ming's scoring system for the motion function in children: The outcome was rate as excellent in 25,good in 4,fair in 1,and poor in 1,the excellent and good rate was 93.6%. Conclusions The Monteggia's fracture in childen should receive an aggressively operative treatment in the early stage,which includes an anatomic reduction of various structures of the elbow joint,rigid internal fixation,repairation or reconstruction of anular ligament and fixation of radiao-humeral joint,exploration and decompression of the involved nerves,with an early functional practice,a satisfactory result can be expected.