本文選題：兒童 + 孟氏骨折��； 參考：《中國矯形外科雜志》2017年16期

【摘要】：[目的]探討前后聯(lián)合入路行關(guān)節(jié)切開復(fù)位、尺骨截骨術(shù)治療兒童陳舊性孟氏骨折的方法及療效。[方法]回顧性分析2010年11月~2015年1月收治的22例陳舊性孟氏骨折患兒資料。男15例,女7例,平均年齡7.5歲。傷后至手術(shù)時間除2例分別為3年、5年外,其余20例為1~12個月�；颊遆線片示橈骨頭脫位,尺骨橈側(cè)或掌側(cè)弓形彎曲,傷后時間長者見橈骨過度生長。2例伴有橈神經(jīng)深支損傷癥狀。所有患兒均采用經(jīng)肘前Henry入路行肱橈關(guān)節(jié)切開、瘢痕徹底清除,有橈神經(jīng)損傷者同時行神經(jīng)探查松解;肘后沿尺骨嵴做縱切口,在尺骨鷹嘴下4~5 cm橫行截骨,矯正尺骨畸形并反向成角、截骨端延長后予鋼板固定。所有患兒均不行環(huán)狀韌帶重建。[結(jié)果]本組患兒隨訪12~59個月,平均15.4個月。根據(jù)Mackay功能評定標準,優(yōu)19例,良2例,差1例。X線片示1例再脫位、2例半脫位,余復(fù)位穩(wěn)定。術(shù)后肘關(guān)節(jié)屈伸功能較術(shù)前改善,差異具有統(tǒng)計學(xué)意義(P0.05);手術(shù)前后前臂旋轉(zhuǎn)功能的差別無統(tǒng)計學(xué)意義(P0.05)。未出現(xiàn)血管神經(jīng)損傷、異位骨化、尺橈骨骨性連接等并發(fā)癥。2例橈神經(jīng)深支損傷患兒3個月內(nèi)恢復(fù)正常。[結(jié)論]前后聯(lián)合入路治療兒童陳舊性孟氏骨折具有術(shù)野顯露好、術(shù)中操作簡便、術(shù)后并發(fā)癥少等優(yōu)勢。前入路允許直視下處理關(guān)節(jié)內(nèi)病理改變,同時便于行橈神經(jīng)探查松解,后入路有利于尺骨截骨矯形術(shù)。
[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.
【作者單位】： 廣西醫(yī)科大學(xué)第一附屬醫(yī)院;南寧市第一人民醫(yī)院;
【基金】：廣西自然科學(xué)基金項目(編號:2010GXNSFA013161)
【分類號】：R726.8

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