Chen BS,Wang S,Shen Y..Surgical treatment of pediatric acute Monteggia fracture with radial nerve injury.[J].Journal of Clinical Pediatric Surgery,2019,18(02):136-140.
儿童急性孟氏骨折伴桡神经损伤的诊治分析
- Title:
- Surgical treatment of pediatric acute Monteggia fracture with radial nerve injury.
- 分类号:
- R726.8 R683.41
- 文献标志码:
- A
- 摘要:
- 目的探讨儿童急性孟氏骨折伴有桡神经损伤的治疗方法和超声检查在儿童孟氏骨折伴桡神经损伤手术治疗中的应用。方法回顾性分析上海交通大学附属儿童医院2010年1月至2017年1月收治的41例儿童急性孟氏骨折伴桡神经损伤患儿的病例资料。临床体格检查及影像学检查确诊为孟氏骨折伴桡神经损伤后，尝试手法复位加石膏固定，其中桡骨头脱位无法复位或复位后不稳定者，以及需要过度屈曲位石膏固定方能获得桡骨头稳定复位者，行急诊超声检查明确存在桡神经损伤，可见神经卡压现象。急诊行手术切开复位加桡神经松解术。其中29例经手法复位石膏固定取得成功，其余12例经急诊手术治疗。12例手术治疗的患儿中，男童5例，女童7例，左侧6例，右侧6例；根据Bado分型，Ⅰ型9例，Ⅱ型1例，Ⅲ型2例；年龄3~11岁，平均5.9岁；从受伤到手术时间4~18 h，平均6.8 h；术中见桡神经损伤均为嵌压损伤，无桡神经断裂病例。术后评估孟氏骨折愈合及复位情况、肘关节活动及桡神经损伤恢复情况。结果所有手术病例均获得随访，随访1~6年，平均2.4年。经手术治疗后，所有孟氏骨折均获得稳定复位，骨折愈合良好，无骨折延迟愈合及不愈合病例，随访过程中未出现桡骨头再脱位。桡神经损伤症状消失，桡神经功能恢复时间70~90 d，平均75 d，肌力均获得完全恢复，肘关节活动恢复正常。根据 BrobergMorrey 的评分标准进行评定，11例为优，1例为良，优良率为100%。结论儿童急性孟氏骨折伴桡神经损伤，通过手法复位无法复位桡骨头或复位后不稳定者，以及需要过度屈曲位石膏固定方能获得桡骨头复位者，可在急诊超声的指导下，行手术治疗，术后可取得理想的效果。
- Abstract:
- ObjectiveTo explore the surgical approaches of pediatric acute Monteggia fracture associated with radial nerve injury and examine the application of emergency ultrasonography in treating pediatric acute Monteggia fracture with radial nerve injury.MethodsA retrospective study was conducted in 41 cases of pediatric acute Monteggia fracture with radial nerve injury from January 2010 to January 2017.After a definite diagnosis of acute Monteggia fracture with radial nerve injury was made through physical examinations and imaging studies,closed reduction and casting were initially performed.When radial head dislocation could not be close or unstably reduced,flexion casting was applied for stable reduction of radial head.Emergency ultrasound was used for confirming radial nerve injury.For nerve compression phenomenon,emergency surgical open reduction and radial nerve releasing were performed.The approaches were closed reduction casting (n=29) and surgery (n=12).There were 5 boys and 7 girls with an average age of 5.9 (3~11) years.The involved side was left (n=6) and right (n=6).According to the Bados classification,the clinical types were Ⅰ(n=9),Ⅱ(n=1) and Ⅲ(n=2).The average time from injury to surgery time was 6.8 (4~18) hours.Extrusion injury was found intraoperatively.The postoperative status was evaluated for fracture healing/reduction,elbow joint movement and radial nerve injury recovery.ResultsAll Monteggia fractures were stably reduced and healed excellently without nonunion.During an average followup period of 2.4 (1~6) years,none showed a redislocation of radial head.The symptoms of radial nerve injury disappeared.The average recovery time of radial nerve function was 75(70~90) days.Muscle strength became fully restored and elbow joint activity returned to normal.According to the BrobergMorreys rating criteria,the outcome was excellent (n=11) and good (n=1).Excellent and good rate was 100%.ConclusionFor pediatric acute Monteggia fracture with radial nerve injury,when radial head dislocation can not be close or unstably reduced,flexion casting is applied for stable reduction of radial head.Ultrasonic guidance may facilitate emergency surgery and postoperative recovery outcome is excellent.
相似文献/References:
[1]杜朝峻,丁力,胡英超,等.手术治疗婴幼儿法洛四联症83例[J].临床小儿外科杂志,2010,9(06):413.
DU Chao jun,DING Li,HU Ying chao,et al.Surgical treatment of Tetralogy of Fallot in infancy: Experiences of 83 cases.[J].Journal of Clinical Pediatric Surgery,2010,9(02):413.
[2]常绘文,沈振亚.右腋下小切口在儿童心内手术中的应用[J].临床小儿外科杂志,2010,9(06):439.
[3]王勇,汤绍涛,毛永忠,等.腔镜下手术治疗小儿膈肌疾病31例[J].临床小儿外科杂志,2010,9(06):441.
[4]欧阳帆,张治明,曾宾,等.七氟醚复合髂腹股沟-髂腹下神经阻滞用于小儿腹股沟手术[J].临床小儿外科杂志,2010,9(06):466.
[5]徐华,赵陶丽.瑞芬太尼对小儿等离子刀扁桃体腺样体切除术应激反应的影响[J].临床小儿外科杂志,2010,9(06):468.
[6]周辉霞孙宁马立飞孟浩谢华伟申州陶天周晓光黄澄如李宏召张旭.腹腔镜下重复肾半肾切除术手术路径探讨[J].临床小儿外科杂志,2011,10(01):0.
ZHOU Hui xia,SU Ning,MA Li fei,et al.Which laparoscopic surgery approach is better for a nonfunctioning moiety in a duplex kidney in infants and children[J].Journal of Clinical Pediatric Surgery,2011,10(02):0.
[7]蒋欣李箭刘利君彭明惺唐学阳.儿童单纯性膝关节骨软骨骨折的关节镜治疗[J].临床小儿外科杂志,2011,10(01):0.
JIANG Xin,LI Jian,LIU Li jun,et al.Arthroscopic therapy of osteochondral fractures of the Knee in children.[J].Journal of Clinical Pediatric Surgery,2011,10(02):0.
[8]王伟程少文彭磊林忠勤张伟陈庆玉寇冬权.弹性髓内钉在儿童肱骨骨折中的应用[J].临床小儿外科杂志,2011,10(01):0.
WANG Wei,CHENG Shaowen,PENG Lei,et al.Application of elastic intramedullary nailing in pediatric humeral fractures.[J].Journal of Clinical Pediatric Surgery,2011,10(02):0.
[9]寿铁军李勇马能强龚晟.腹腔镜手术治疗小儿腹股沟斜疝1582例[J].临床小儿外科杂志,2011,10(01):0.
[10]吴臻斐陈聪德林进汉刘平李仲荣陈肖鸣.小儿急性肠套叠肠坏死相关因素分析[J].临床小儿外科杂志,2011,10(01):0.