本文關(guān)鍵詞： 兒童 陳舊性孟氏骨折 外固定架 重建鋼板　出處：《山東大學(xué)》2017年碩士論文　論文類型：學(xué)位論文

【摘要】：目的孟氏骨折(Monteggia's fracture)是指尺骨骨折合并肱橈關(guān)節(jié)脫位。兒童孟氏骨折致傷機制復(fù)雜、臨床表現(xiàn)多樣,結(jié)合兒童這一特殊病患群體以及兒童骨骼生長發(fā)育的特殊性,此類疾病在臨床實踐過程中容易產(chǎn)生誤診或者漏診,從而導(dǎo)致兒童陳舊性孟氏骨折。急性期兒童孟氏骨折多主張保守治療,在麻醉狀態(tài)下行橈骨小頭閉合復(fù)位、石膏外固定術(shù),可以取得滿意結(jié)果。急性期發(fā)生漏診、誤診或者處置不當(dāng),骨折進入陳舊期,多數(shù)學(xué)者認為孟氏骨折傷后超過兩周沒有得到正確有效的治療,即可診斷為陳舊性孟氏骨折。兒童陳舊性孟氏骨折保守治療效果差,多殘留嚴重的并發(fā)癥。對于兒童陳舊性孟氏骨折多數(shù)學(xué)者主張采取手術(shù)治療的辦法,治療的關(guān)鍵在于矯正尺骨畸形,恢復(fù)并維持肱橈關(guān)節(jié)的解剖關(guān)系。尺骨截骨糾正尺骨畸形已經(jīng)是業(yè)界的共識,但是術(shù)中截斷尺骨、糾正尺骨畸形后采用何種方法重新固定尺骨,并沒有一個統(tǒng)一的標(biāo)準。本次研究總結(jié)兒童陳舊性孟氏骨折行尺骨截骨矯形后采用兩種方法固定尺骨后的近期及遠期效果,從而對應(yīng)用重建鋼板或外固定架在治療兒童陳舊性孟氏骨折時何種方法更具優(yōu)勢作出評價。方法收集山東大學(xué)齊魯醫(yī)院小兒外科自2011年3月至2015年4月兒童陳舊性孟氏骨折患者33例,分別采用尺骨截骨后重建鋼板固定尺骨治療兒童陳舊性孟氏骨折,以及尺骨截骨后外固定架固定尺骨治療兒童陳舊性孟氏骨折。將研究對象按照尺骨截骨后固定方式不同分為重建鋼板組和外固定架組,重建鋼板組入選病例數(shù)13人,外固定架組入選病例數(shù)20人,進行回顧性研究。外固定架組病例患兒年齡2歲～15歲,平均年齡為7歲。外傷史3個月～14個月,平均傷后7個月。鋼板組病例患兒年齡3歲～13歲,平均年齡為6.7歲。外傷史3個月～12個月,平均傷后6個月;其中重建鋼板組男性患兒10例,女性患兒3例;外固定架組男性患兒16例,女性患兒4例。重建鋼板組左側(cè)患肢2例,右側(cè)患肢11例;外固定架組左側(cè)患肢3例,右側(cè)患肢17例。按照孟氏骨折Bado分型,重建鋼板組BadoⅠ型患兒10例,Bado Ⅲ型患兒3例;外固定架組Bado Ⅰ型患兒16例,Bado Ⅲ型患兒4例。手術(shù)方式:兩組病例均采用尺骨截骨矯形,肱橈關(guān)節(jié)切開復(fù)位,環(huán)狀韌帶修補術(shù)。術(shù)后屈肘90度,前臂旋后位高分子夾板外固定,術(shù)后4周拆除高分子夾板后行肘關(guān)節(jié)功能鍛煉。術(shù)后第2天,第7天復(fù)查包含肘關(guān)節(jié)在內(nèi)的患肢前臂X線正側(cè)位片,術(shù)后1個月,2個月,3個月,術(shù)后6個月門診復(fù)查,以后每6個月門診復(fù)查。以手術(shù)時間、術(shù)中出血量、術(shù)后肘關(guān)節(jié)腫脹指數(shù)、術(shù)后住院天數(shù)為指標(biāo),對兩種不同固定方式的近期效果作出評估;術(shù)后半年門診復(fù)查按照Mayo肘關(guān)節(jié)功能評分標(biāo)準(MEPS)對兩種不同的固定尺骨方法的遠期效果進行評估。結(jié)果兩組病例隨訪時間2年～6年,平均隨訪4年。兩組病例年齡、性別、損傷類型、損傷程度方面沒有顯著地統(tǒng)計學(xué)差異,兩組病例具有可比性。使用手術(shù)室計時器收集并記錄兩組病例的手術(shù)時間;以每塊蘸滿血的紗布血量為3ml計算得出兩組病例的術(shù)中出血量;患肘腫脹程度評價方法是同自身健側(cè)肘關(guān)節(jié)作比較,術(shù)后7天測量患肘周徑。使用軟皮尺(毫米刻度)自尺骨鷹嘴繞肘部一周并記錄數(shù)據(jù)。健側(cè)肘周徑16.78±1.77cm,患肘外架組周徑21.07±1.34cm,鋼板組周徑24.03± 1.33 cm;按照患側(cè)肘周徑超過健側(cè)的百分比將肘腫脹程度分輕、中、重三度。計算方法:患側(cè)肘周徑-健側(cè)肘周徑/健側(cè)肘周徑×100%。小于15%為輕度腫脹,15%-25%之間為中度腫脹,大于25%為腫脹;隨訪結(jié)果:外固定架組手術(shù)平均時間(忽略麻醉前及麻醉清醒時間)2小時,重建鋼板組手術(shù)平均時間2.5小時,外固定架組平均手術(shù)耗時短于重建鋼板組(P0.05),有統(tǒng)計學(xué)意義;外固定架組術(shù)中出血量平均15ml,重建鋼板組術(shù)中出血量平均30ml,外固定架組術(shù)中平均出血量顯著少于重建鋼板組(P0.05),數(shù)據(jù)有統(tǒng)計學(xué)意義;外架組輕度腫脹14例,中度腫脹6例,重度腫脹0例;鋼板組輕度腫脹1例,中度腫脹11例,重度腫脹1例,二者相比外固定架組術(shù)后七天肘關(guān)節(jié)消腫迅速(P0.05)有統(tǒng)計學(xué)意義。術(shù)后一,二,三,六個月門診復(fù)查,以后每半年門診復(fù)查,術(shù)后半年根據(jù)Mayo肘關(guān)節(jié)功能評分標(biāo)準,外固定架組優(yōu)16例,良3例,中1例,差0例;重建鋼板組優(yōu)8例,良2例,中1例,差2例。外固定架組優(yōu)良率95%,重建鋼板組優(yōu)良率77%,二者相較(P0.05)有統(tǒng)計學(xué)意義結(jié)論兒童陳舊性孟氏骨折采用手術(shù)治療,行尺骨截骨矯形,肱撓關(guān)節(jié)切開復(fù)位,環(huán)狀韌帶修補術(shù),可以取得滿意效果。尺骨截骨后采用外固定架固定尺骨同采用重建鋼板固定尺骨作比較,外固定架固定尺骨具有手術(shù)操作簡單,手術(shù)時間短,術(shù)中軟組織及尺骨損傷小,術(shù)后恢復(fù)快、住院時間短,以及遠期肘關(guān)節(jié)功能恢復(fù)更好等一系列優(yōu)勢。因此我們有理由相信,手術(shù)治療兒童陳舊性孟氏骨折,尺骨截骨后使用外固定架或重建鋼板固定均可取得滿意結(jié)果。二者相比,外固定架更具優(yōu)勢,值得推廣。
[Abstract]:The purpose of Monteggia fracture (Monteggia's fracture) refers to the ulna fracture combined with dislocation of humeroradial joint complex injury mechanism of Monteggia fracture in children, clinical manifestations, combined with the children of this special patient population and children's bone growth and development particularity, this kind of disease is prone to misdiagnosis or missed diagnosis in clinical practice, which leads to the old children Monteggia fracture. Acute Monteggia fracture for conservative treatment in anesthesia for radial head closed reduction and plaster external fixation, can obtain satisfactory results. The acute period of misdiagnosis, misdiagnosis or improper disposal of fracture into the old period, the majority of scholars believe that the correct and effective treatment has not been more than two weeks of Monteggia fracture after injury, can be diagnosed as old Monteggia fracture. Old Monteggia fracture in the conservative treatment of poor children, residual serious complications. For children of old Many scholars advocate Monteggia fracture surgical treatment method, treatment is the key to the correction of deformity, restore and maintain the anatomical relationship between the humeroradial joint. The osteotomy of ulna deformity was corrected of the consensus of the industry, but in the operation of truncation, correction of deformity after ulna which method is adopted to fix the ulna, and not a unified standard. This research summary for old Monteggia fractures in children with ulna osteotomy for short-term and long-term effects of the two methods of fixed after the application of reconstruction plate or external fixator in the treatment of old Monteggia fracture in children which method has more advantages to evaluate methods of pediatric surgery, Qilu Hospital of Shandong University. From March 2011 to April 2015 the old Monteggia fracture in 33 cases, respectively using the ulnar osteotomy after reconstruction plate fixation of treatment of children's old Meng 姘忛鎶，

本文編號：1488742