前后联合入路治疗儿童陈旧性孟氏骨折

发布时间：2018-04-16 21:28

本文选题：儿童 + 孟氏骨折　；参考：《中国矫形外科杂志》2017年16期

【摘要】：[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(P0.05);手术前后前臂旋转功能的差别无统计学意义(P0.05)。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。
[Abstract]:Objective: to explore the method and effect of joint open reduction and ulnar osteotomy in the treatment of old Monteggia fracture in children.[methods] the data of 22 children with old Monteggia fracture from November 2010 to January 2015 were analyzed retrospectively.There were 15 males and 7 females with an average age of 7.5 years.The time from injury to operation was 1 ~ 12 months in 20 cases except 2 cases for 3 years and 5 years respectively.The radiographs showed dislocation of the radial head, radial or metacarpal arcuate bending, and overgrowth of the radius was seen in 2 cases with deep radial nerve injury.All the children underwent brachioradial joint incision through anterior Henry approach, complete removal of scar, nerve exploration and release in patients with radial nerve injury, longitudinal incision along ulnar ridge after elbow, osteotomy at 45 cm below ulnar olecranon.Ulna deformities were corrected and angled in reverse direction. The osteotomy was fixed with steel plate after lengthening.All the children could not reconstruct the annular ligament.[results] the children were followed up for 12 ~ 59 months with an average of 15.4 months.According to Mackay functional evaluation criteria, excellent in 19 cases, good in 2 cases, and poor in 1 case. X-ray showed that 1 case had subluxation and 2 cases had subluxation, and the remaining reduction was stable.The function of elbow flexion and extension was improved after operation, and the difference was statistically significant (P 0.05), but there was no significant difference in the function of forearm rotation before and after operation (P 0.05).There were no vascular and nerve injury, ectopic ossification, ossification of ulna and radius, and so on. 2 cases of children with deep branch injury of radial nerve returned to normal within 3 months.[conclusion] the combined anterior and posterior approach for the treatment of old Monteggia fracture in children has the advantages of good exposure of operative field, simple operation and less postoperative complications.The anterior approach allows the treatment of intraarticular pathological changes under direct vision, and facilitates the exploration and release of the radial nerve. The posterior approach is beneficial to osteotomy and orthopedics of the ulna.
【作者单位】：广西医科大学第一附属医院;南宁市第一人民医院;
【基金】：广西自然科学基金项目(编号:2010GXNSFA013161)
【分类号】：R726.8

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