孟氏骨折新分型与前臂骨间膜损伤MRI表现的相关性分析

发布时间：2018-07-03 05:42

本文选题：孟氏骨折 + 新分型　；参考：《河南中医药大学》2016年硕士论文

【摘要】：目的1分析新鲜儿童孟氏骨折DR、MRI影像学资料,观察前臂骨间膜损伤的MRI表现及损伤范围,评估上尺桡关节分离程度和前臂骨间膜损伤程度。2探讨上尺桡关节分离程度与骨间膜损伤程度的相关性,评估一种以上尺桡关节分离程度为分型依据的新型孟氏骨折分类系统,以优化孟氏骨折治疗策略。对象与方法1研究对象:采用前瞻性研究方法,研究从2013年10月开始,2015年8月截止。选取我院收治的符合纳入标准的38名患者作为研究对象,其中男24例,女14例,年龄5-11岁,平均年龄6.9岁,左侧13例,右侧25例,合并伤肢同侧桡骨远端骨骺骨折1例,合并桡神经损伤6例,尺神经损伤1例。Bado分型:BadoⅠ型17例,BadoⅡ型1例,BadoⅢ型18例,BadoⅣ型2例;新分型理论分型:新Ⅰ型12例,新Ⅱ型24例,新Ⅲ型2例。所有患者均为闭合性损伤,均为1周内的新鲜损伤,受伤至入院治疗的时间为1小时-7天,平均时间为32.6个小时。2方法:新Ⅰ型、新Ⅱ型入院病情稳定后给予前臂MRI检查,MRI检查前均与家属沟通并签署MRI检查安全知情同意书。采用1.5T超导型MR扫描机(Magnetom Essenza),肘关节表面柔顺线圈,病人仰卧、上肢伸直前臂旋后位。分别扫描横轴位,矢状位,冠状位,主要采取横轴面扫描。横轴位获得T1WI,T2WI,T2脂肪抑制图像,扫描层厚为3-5mm,间距为1mm,扫描范围为肘关节至腕关节前臂全长。MRI图像质量以肌腱、肌肉、筋膜轮廓显示清楚,无伪影为优。对比正常儿童前臂骨间膜MRI图像,观察轴位骨间膜MRI图像病理改变,记录不同病理改变的轴面层数(病理改变的距离),测量患肢X线肘关节标准正侧位片上尺桡关节分离距离,统计学分析上尺桡关节分离距离与骨间膜损伤距离的相关性。依据新分型理论指导治疗,根据肘关节美国特种外科医院(HSS)评分标准评价术后6个月肘关节功能,观察新分型理论指导临床治疗的临床疗效。结果1 4名患者因不能配合MRI检查而未能获得MRI图像,其中新Ⅰ型1例,新Ⅱ3例,最终获得11例新Ⅰ型,21例新Ⅱ患者的影像学资料。以桡骨头环状软骨面为起点,轴位骨间膜MRI图像距离环状软骨面以远30mm-45mm左右开始显示,轴位TWI1,TWI2图像可显示完整的前臂骨间膜为连接尺桡骨间均匀的、连续的线状低信号带,与周围中等信号的软组织对比明显,冠状位,矢状位图像无法分辨出骨间膜。2损伤的范围:11例新Ⅰ型儿童孟氏骨折均伴有前臂骨间膜损伤,其中7例骨间膜损伤且伴有断裂,4例骨间膜有损伤但无断裂。21例新Ⅱ型孟氏骨折均伴有前臂骨间膜损伤,18例伴有骨间膜有损伤且伴有断裂,3例骨间膜有损伤但无断裂。新Ⅰ型上尺桡关节轻度分离,骨间膜主要病理表现为损伤的距离短,断裂距离短;新Ⅱ型上尺桡关节重度分离,骨间膜损伤距离长,断裂距离长。骨间膜损伤程度与上尺桡关节单位长度被拉长的距离有关。采用Pearson′s相关性分析,上尺桡关节分离程度与骨间膜病理改变距离呈正相关(r=0.799,P=0.000),P0.05。3 34例患者获术后6-18个月(平均9.5个月)随访(随访率89.47%),患者骨折愈合良好,对位、对线可,未见畸形愈合,延迟愈合,无钉道感染,骨髓炎发生,外观及关节功能良好。根据肘关节美国特种外科医院(HSS)评分标准,优90-100分;良80-89分;可70-79分;差60-69分。新Ⅰ型优8例,良2例,可1例,新Ⅱ型优13例,良7例,可1例,新Ⅲ型良1例,可1例。优良率为91.18%。结论MRI能够观察前臂骨间膜损伤情况,诊断骨间膜损伤类型;上尺桡关节分离程度与前臂骨间膜损伤程度具有相关性;孟氏骨折新分型理论能够优化孟氏骨折治疗策略,很好的指导临床治疗方式的选择。
[Abstract]:Objective 1 to analyze the DR and MRI imaging data of fresh children's Monteggia fracture, to observe the MRI manifestations and damage range of the forearm interosseous membrane injury, to evaluate the degree of separation of the ulnar and radial joints and the degree of the injury of the forearm interosseous membrane, to explore the correlation between the degree of separation of the ulnar and the radial joint and the degree of interosseous membrane injury, and to evaluate the degree of separation of the ulnar and radial joints as a score. A new type of Monteggia fracture classification system was used to optimize the treatment strategy of Monteggia fracture. Object and method 1 object and method: a prospective study was used to study 38 patients in our hospital from October 2013 and August 2015. The subjects were 24 men, 14 women, 5-11 years old and average year. 6.9 years old, 13 cases on the left side, 25 cases on the right side, 1 cases of distal epiphyseal fracture in the same side of the injured limb, 6 cases of radial nerve injury and 1 cases of ulnar nerve injury.Bado typing: 17 cases of Bado I, 1 cases of Bado II, 18 cases of Bado III, 2 cases of Bado IV, new type I 12, new type II 24 cases, and new type III 2 cases. All patients were closed injury. They were all fresh injuries within 1 weeks, and the time of injury to admission was 1 hours -7 days, the average time was 32.6 hours.2 method: new type I, new type II admission to the forearm MRI examination, MRI examination before the examination and the signing of the MRI inspection safety informed consent. 1.5T superconducting MR scanner (Magnetom Essenza), elbow A flexible coils on the surface of the joint, the patient lying on the back, and the upper arm straightening in the forearm. Scanning the transverse axis, sagittal position and coronal position respectively, the transverse axis was scanned with transverse axis. The transverse axial position obtained the T1WI, T2WI, T2 fat suppression image, the thickness of the scanning layer was 3-5mm, the distance was 1mm, and the scanning range was the total length of.MRI image quality of the elbow to wrist joint to the tendon and muscle. The MRI images of the interosseous membrane of the normal children were compared and the pathological changes of the MRI images of the axial interosseous membrane were observed, and the number of axial planes of different pathological changes (the distance of the pathological changes) was recorded. The separation distance of the ulnar and radial joint on the standard lateral segment of the elbow joint of the affected limb was measured, and the separation of the ulnar and radial joint was statistically analyzed. The correlation between distance and the distance between the interosseous membrane injury. According to the new classification theory, the function of the elbow joint was evaluated 6 months after the operation in the United States special surgical hospital (HSS) of the elbow joint. The clinical efficacy of the new classification theory was observed to guide the clinical treatment. Results 14 patients failed to obtain the MRI image because of the failure to cooperate with the examination. Type I 1 cases, new II 3 cases, and finally obtain 11 cases of new type I and 21 cases of new II patients, with the radial head cricoid surface as the starting point, the axial interosseous membrane MRI image begins to show around the cricoid surface at about 30mm-45mm, the axis position TWI1, the TWI2 image can show the complete interosseous interosseous membrane of the ulnar and the continuous line. The lower signal band was compared with the soft tissue of the surrounding medium. The coronal and sagittal images could not distinguish the range of.2 damage in the interosseous membrane: 11 cases of new type I children with Monteggia fracture were associated with the forearm interosseous membrane damage, including 7 cases of interosseous membrane damage and fracture, 4 cases of interosseous membrane damage but no fracture of.21 new type II Monteggia fracture The interosseous membrane injury in the forearm, 18 cases with interosseous membrane injury and fracture, 3 cases of interosseous membrane injury but no fracture, the new type I upper ulnar radial joint was slightly separated, the main pathological features of the interosseous membrane were the short distance of injury and the short fracture distance; the new type II upper ulnar radial joint was separated, the distance of the interosseous membrane was long, the distance of the fracture was long. Interosseous membrane was long. The degree of injury was related to the distance between the length and length of the ulnar radial joint. Using Pearson 's correlation analysis, the degree of separation of the radial joint of the upper ulnar was positively correlated with the distance of the pathological changes of the interosseous membrane (r=0.799, P=0.000). 34 cases of P0.05.3 patients were followed up for 6-18 months (average 9.5 months) after the operation (the follow-up rate was 89.47%). There was no malunion, delayed union, no nailed healing, no nail tract infection, osteomyelitis, appearance and joint function. According to the standard of American special surgical hospital (HSS) of the elbow joint, excellent 90-100 points, good 80-89 points, 70-79 points, 60-69 good 8 cases, good 2 cases, 1 good 13 cases, 7 good cases, 1 cases, 1 cases of new type III, and 1 cases The excellent rate is 91.18%. conclusion MRI can observe the injury of the interosseous membrane of the forearm, diagnose the type of interosseous membrane damage, the degree of separation of the upper ulnar radial joint and the degree of the forearm interosseous membrane damage, and the new classification theory of Monteggia fracture can optimize the treatment strategy of Monteggia fracture, which is a good choice for the treatment of clinical treatment.
【学位授予单位】：河南中医药大学
【学位级别】：硕士
【学位授予年份】：2016
【分类号】：R726.8

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