本文選題：孟氏骨折 + 新分型　； 參考：《河南中醫(yī)藥大學(xué)》2016年碩士論文

【摘要】：目的1分析新鮮兒童孟氏骨折DR、MRI影像學(xué)資料,觀察前臂骨間膜損傷的MRI表現(xiàn)及損傷范圍,評(píng)估上尺橈關(guān)節(jié)分離程度和前臂骨間膜損傷程度。2探討上尺橈關(guān)節(jié)分離程度與骨間膜損傷程度的相關(guān)性,評(píng)估一種以上尺橈關(guān)節(jié)分離程度為分型依據(jù)的新型孟氏骨折分類(lèi)系統(tǒng),以優(yōu)化孟氏骨折治療策略。對(duì)象與方法1研究對(duì)象:采用前瞻性研究方法,研究從2013年10月開(kāi)始,2015年8月截止。選取我院收治的符合納入標(biāo)準(zhǔn)的38名患者作為研究對(duì)象,其中男24例,女14例,年齡5-11歲,平均年齡6.9歲,左側(cè)13例,右側(cè)25例,合并傷肢同側(cè)橈骨遠(yuǎn)端骨骺骨折1例,合并橈神經(jīng)損傷6例,尺神經(jīng)損傷1例。Bado分型:BadoⅠ型17例,BadoⅡ型1例,BadoⅢ型18例,BadoⅣ型2例;新分型理論分型:新Ⅰ型12例,新Ⅱ型24例,新Ⅲ型2例。所有患者均為閉合性損傷,均為1周內(nèi)的新鮮損傷,受傷至入院治療的時(shí)間為1小時(shí)-7天,平均時(shí)間為32.6個(gè)小時(shí)。2方法:新Ⅰ型、新Ⅱ型入院病情穩(wěn)定后給予前臂MRI檢查,MRI檢查前均與家屬溝通并簽署MRI檢查安全知情同意書(shū)。采用1.5T超導(dǎo)型MR掃描機(jī)(Magnetom Essenza),肘關(guān)節(jié)表面柔順線圈,病人仰臥、上肢伸直前臂旋后位。分別掃描橫軸位,矢狀位,冠狀位,主要采取橫軸面掃描。橫軸位獲得T1WI,T2WI,T2脂肪抑制圖像,掃描層厚為3-5mm,間距為1mm,掃描范圍為肘關(guān)節(jié)至腕關(guān)節(jié)前臂全長(zhǎng)。MRI圖像質(zhì)量以肌腱、肌肉、筋膜輪廓顯示清楚,無(wú)偽影為優(yōu)。對(duì)比正常兒童前臂骨間膜MRI圖像,觀察軸位骨間膜MRI圖像病理改變,記錄不同病理改變的軸面層數(shù)(病理改變的距離),測(cè)量患肢X線肘關(guān)節(jié)標(biāo)準(zhǔn)正側(cè)位片上尺橈關(guān)節(jié)分離距離,統(tǒng)計(jì)學(xué)分析上尺橈關(guān)節(jié)分離距離與骨間膜損傷距離的相關(guān)性。依據(jù)新分型理論指導(dǎo)治療,根據(jù)肘關(guān)節(jié)美國(guó)特種外科醫(yī)院(HSS)評(píng)分標(biāo)準(zhǔn)評(píng)價(jià)術(shù)后6個(gè)月肘關(guān)節(jié)功能,觀察新分型理論指導(dǎo)臨床治療的臨床療效。結(jié)果1 4名患者因不能配合MRI檢查而未能獲得MRI圖像,其中新Ⅰ型1例,新Ⅱ3例,最終獲得11例新Ⅰ型,21例新Ⅱ患者的影像學(xué)資料。以橈骨頭環(huán)狀軟骨面為起點(diǎn),軸位骨間膜MRI圖像距離環(huán)狀軟骨面以遠(yuǎn)30mm-45mm左右開(kāi)始顯示,軸位TWI1,TWI2圖像可顯示完整的前臂骨間膜為連接尺橈骨間均勻的、連續(xù)的線狀低信號(hào)帶,與周?chē)械刃盘?hào)的軟組織對(duì)比明顯,冠狀位,矢狀位圖像無(wú)法分辨出骨間膜。2損傷的范圍:11例新Ⅰ型兒童孟氏骨折均伴有前臂骨間膜損傷,其中7例骨間膜損傷且伴有斷裂,4例骨間膜有損傷但無(wú)斷裂。21例新Ⅱ型孟氏骨折均伴有前臂骨間膜損傷,18例伴有骨間膜有損傷且伴有斷裂,3例骨間膜有損傷但無(wú)斷裂。新Ⅰ型上尺橈關(guān)節(jié)輕度分離,骨間膜主要病理表現(xiàn)為損傷的距離短,斷裂距離短;新Ⅱ型上尺橈關(guān)節(jié)重度分離,骨間膜損傷距離長(zhǎng),斷裂距離長(zhǎng)。骨間膜損傷程度與上尺橈關(guān)節(jié)單位長(zhǎng)度被拉長(zhǎng)的距離有關(guān)。采用Pearson′s相關(guān)性分析,上尺橈關(guān)節(jié)分離程度與骨間膜病理改變距離呈正相關(guān)(r=0.799,P=0.000),P0.05。3 34例患者獲術(shù)后6-18個(gè)月(平均9.5個(gè)月)隨訪(隨訪率89.47%),患者骨折愈合良好,對(duì)位、對(duì)線可,未見(jiàn)畸形愈合,延遲愈合,無(wú)釘?shù)栏腥?骨髓炎發(fā)生,外觀及關(guān)節(jié)功能良好。根據(jù)肘關(guān)節(jié)美國(guó)特種外科醫(yī)院(HSS)評(píng)分標(biāo)準(zhǔn),優(yōu)90-100分;良80-89分;可70-79分;差60-69分。新Ⅰ型優(yōu)8例,良2例,可1例,新Ⅱ型優(yōu)13例,良7例,可1例,新Ⅲ型良1例,可1例。優(yōu)良率為91.18%。結(jié)論MRI能夠觀察前臂骨間膜損傷情況,診斷骨間膜損傷類(lèi)型;上尺橈關(guān)節(jié)分離程度與前臂骨間膜損傷程度具有相關(guān)性;孟氏骨折新分型理論能夠優(yōu)化孟氏骨折治療策略,很好的指導(dǎo)臨床治療方式的選擇。
[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.
【學(xué)位授予單位】：河南中醫(yī)藥大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2016
【分類(lèi)號(hào)】：R726.8

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