Gu Zhenkun,Zhang Chen,Li Jiahui,et al.Clinical management of pediatric Monteggia fractures:a single-center experience of 1 129 cases[J].Journal of Clinical Pediatric Surgery,2025,(11):1056-1060.[doi:10.3760/cma.j.cn101785-202502022-012]
单中心1 129例儿童孟氏骨折现况研究
- Title:
- Clinical management of pediatric Monteggia fractures:a single-center experience of 1 129 cases
- Keywords:
- Ulna Fractures; Peripheral Nerve Injuries; Epidemiology; Child
- 摘要:
- 目的 对单中心接受手术治疗的儿童孟氏骨折患者进行现状分析。方法 回顾性分析深圳市儿童医院2013年1月至2023年12月收治的1129例孟氏骨折并接受手术治疗患儿的临床资料,收集患儿年龄、性别、受伤时间、损伤机制、手术相关信息,并进行描述性分析,在此基础上进一步探讨孟氏骨折神经损伤与Bado分型、骨折类型(开放/闭合)之间的关联性。结果 1 129例儿童孟氏骨折手术患者中,男740例、女389例,高发年龄段为3~6岁(50.3%,568/1 129),低于1米处跌落是致伤的最主要原因(88.7%,1 001/1 129),最主要的手术方式是骨折闭合复位后克氏针内固定(92.2%,1 041/1 129),急性神经损伤是孟氏骨折最常见的并发症(16.3%,184/1 129)。Bado分型占比从高到低依次为:3型(43.8%,495/1 129)、1型(35.1%,396/1 129)、2型(17.9%,202/1 129)、4型(3.2%,36/1 129);Bado分型与神经损伤的关联性无统计学意义(χ2=2.381,P＞0.05),神经损伤与骨折类型的关联性有统计学意义(χ2=5.284,P=0.034)。结论 深圳市儿童医院近年来收治的孟氏骨折患儿中,3~6岁是儿童孟氏骨折的最高发年龄段,主要由低处跌倒引起;Bado分型中3型占比最高;急性神经损伤是孟氏骨折最常见的并发症,需仔细检查开放性骨折患儿的神经功能。
- Abstract:
- Objective To explore the clinical characteristics of pediatric Monteggia fractures treated surgically at a single center. Methods Retrospective analysis was conducted for 1129 children operated for Monteggia fractures between January 2013 and December 2023.Personal demographics,injury mechanisms and surgical profiles were descriptively analyzed.Furthermore,potential associations were explored between Bado classification,presence of nerve injury and fracture type (open/closed). Results This cohort comprised of 740 boys and 389 girls.The highest incidence was recorded in 3 to 6-year-old age group (50.3%,568/1 129).The most predominant cause of injury was falling from a height of under 1 meter (88.7%,1 001/1 129).Closed reduction with Kirschner wire internal fixation was the most commonly performed surgical procedure (92.2%,1 101/1 129).The most common complication was acute nerve injury,occurring in 16.3% of cases (184/1 129).According to the Bado classification,type Ⅲ was the most prevalent (43.8%,495/1 129),followed by type Ⅰ (35.1%,396/1 129),type Ⅱ (17.9%,202/1 129) and type Ⅳ (3.2%,36/1 129).No significant association was identified between Bado classification and nerve injury (χ2=2.381,P>0.05).However,a statistically significant association occurred between nerve injury and whether or not fracture was open or closed (χ2=5.284,P=0.034).Inter-observer reliability for Bado classification was excellent among orthopedic surgeons (κ=0.947). Conclusions Children aged 3-6 years are at the highest risk for Monteggia fractures due to low-energy falls.Bado type Ⅲ fracture is the most common variant.Acute nerve injury is a frequent complication.It is imperative to attach great importance to meticulous neurological assessments,particularly in children with open fractures.
参考文献/References:
[1] 周义军, 杨戈, 柏晓安, 等.桡骨远近端骺板中点连线和传统桡骨肱骨小头线诊断儿童孟氏骨折的对比研究[J]. 临床小儿外科杂志, 2023, 22(8): 773-777. DOI: 10.3760/cma.j.cn101785-202307046-014. Zhou YJ, Yang G, Bai XA, et al.Comparative study of midpoint line of proximal-distal epiphyseal of radius versus traditional radiocapitellar in the diagnosis of pediatric Monteggia’s fracture[J]. DOI: 10.3760/cma.j.cn101785-202307046-014.
[2] Klug A, Konrad F, Gramlich Y, et al.Surgical treatment of the radial head is critical to the outcome of Monteggia-like lesions[J]. Bone Joint J, 2019, 101-B(12): 1512-1519. DOI: 10.1302/0301-620X.101B12.BJJ-2019-0547.R1.
[3] Korner J, Hansen M, Weinberg A, et al.Monteggia fractures in childhood-diagnosis and management in acute and chronic cases[J]. Eur J Trauma, 2004, 30(6): 361-370. DOI: 10.1007/s00068-004-1343-7.
[4] Miller TC, Fishman FG.Management of Monteggia injuries in the pediatric patient[J]. Hand Clin, 2020, 36(4): 469-478. DOI: 10.1016/j.hcl.2020.07.001.
[5] Scuccimarra T, Fidanza A, Marzilli F, et al.Monteggia lesions:tips & tricks in acute management and 2-years follow-up[J]. Lo Scalpello, 2021, 35(3): 146-150. DOI: 10.36149/0390-5276-231.
[6] Soni JF, Valenza WR, Pavelec AC.Chronic Monteggia[J]. Curr Opin Pediatr, 2019, 31(1): 54-60. DOI: 10.1097/MOP.0000000000000710.
[7] Tan SHS, Low JY, Chen H, et al.Surgical management of missed pediatric Monteggia fractures:a systematic review and meta-analysis[J]. J Orthop Trauma, 2022, 36(2): 65-73. DOI: 10.1097/BOT.0000000000002219.
[8] Zivanovic D, Marjanovic Z, Bojovic N, et al.Neglected Monteggia fractures in children-a retrospective study[J]. Children (Basel), 2022, 9(8): 1100. DOI: 10.3390/children9081100.
[9] Ko KR, Shim JS, Park J, et al.Predictors of ideal outcomes after reconstructive surgery for chronic Monteggia fracture in children[J]. J Orthop Sci, 2022, 27(5): 1025-1031. DOI: 10.1016/j.jos.2021.06.009.
[10] Dukan R, Le Hanneur M, Pannier S, et al.Use of an external fixator during one-step surgical management of missed chronic Monteggia injuries[J]. Orthop Traumatol Surg Res, 2022, 108(1): 102963. DOI: 10.1016/j.otsr.2021.102963.
[11] Dai ZZ, Xu J, Zhang ZQ, et al.Risk factors for redislocation of chronic Monteggia fracture-dislocation in children after reconstruction surgery[J]. Int Orthop, 2022, 46(10): 2299-2306. DOI: 10.1007/s00264-022-05473-3.
[12] 查国春, 孙俊英, 陈向阳, 等.不同年龄髋臼骨折的临床流行病学特征[J]. 中华骨科杂志, 2016, 36(18): 1175-1184. DOI: 10.3760/cma.j.issn.0253-2352.2016.18.005. Zha GC, Sun JY, Chen XY, et al.Clinical epidemiology features of acetabular fracture in patients with different ages[J]. Chin J Orthop, 2016, 36(18): 1175-1184. DOI: 10.3760/cma.j.issn.0253-2352.2016.18.005.
[13] Weber MM, Rosteius T, Schildhauer TA, et al.Monteggia fractures and Monteggia-like-lesions:a systematic review[J]. Arch Orthop Trauma Surg, 2023, 143(7): 4085-4093. DOI: 10.1007/s00402-022-04576-1.
[14] K rner D, Gonser CE, Bahrs C, et al.Change in paediatric upper extremity fracture incidences in German hospitals from 2002 to 2017:an epidemiological study[J]. Arch Orthop Trauma Surg, 2020, 140(7): 887-894. DOI: 10.1007/s00402-019-03321-5.
[15] Clark P, Montiel-Ojeda D, Rascón-Pacheco RA, et al.Fracture incidence in children and adolescents 0-19 years old in Mexico:a 12-year cross-sectional analysis[J]. Arch Osteoporos, 2022, 17(1): 127. DOI: 10.1007/s11657-022-01162-1.
[16] Rennie L, Court-Brown CM, Mok JYQ, et al.The epidemiology of fractures in children[J]. Injury, 2007, 38(8): 913-922. DOI: 10.1016/j.injury.2007.01.036.
[17] Lee JCY, Tung KTS, Li TMH, et al.Fall-related attendance and associated hospitalisation of children and adolescents in Hong Kong:a 12-year retrospective study[J]. BMJ Open, 2017, 7(2): e013724. DOI: 10.1136/bmjopen-2016-013724.
[18] 李佳, 孙家元, 李石伦, 等.2010年至2011年中国东部地区与西部地区孟氏骨折的流行病学对比分析[J]. 中华创伤骨科杂志, 2017, 19(6): 518-522. DOI: 10.3760/cma.j.issn.1671-7600.2017.06.011. Li J, Sun JY, Li SL, et al.Epidemiological characteristics of Monteggia fractures in the east and west areas in China from 2010 to 2011[J]. Chin J Orthop Trauma, 2017, 19(6): 518-522. DOI: 10.3760/cma.j.issn.1671-7600.2017.06.011.
[19] ?epelík M, Pe?l T, Hendrych J, et al.Monteggia lesion and its equivalents in children[J]. J Child Orthop, 2019, 13(6): 560-568. DOI: 10.1302/1863-2548.13.190131.
[20] Foran I, Upasani VV, Wallace CD, et al.Acute pediatric Monteggia fractures:a conservative approach to stabilization[J]. J Pediatr Orthop, 2017, 37(6): e335-e341. DOI: 10.1097/BPO.0000000000001001.
[21] Leonidou A, Pagkalos J, Lepetsos P, et al.Pediatric Monteggia fractures:a single-center study of the management of 40 patients[J]. J Pediatr Orthop, 2012, 32(4): 352-356. DOI: 10.1097/BPO.0b013e31825611fc.
[22] Delpont M, Louahem D, Cottalorda J.Monteggia injuries[J]. Orthop Traumatol Surg Res, 2018, 104(1S): S113-S120. DOI: 10.1016/j.otsr.2017.04.014.
[23] Li H, Cai QX, Shen PQ, et al.Posterior interosseous nerve entrapment after Monteggia fracture-dislocation in children[J]. Chin J Traumatol, 2013, 16(3): 131-135.
[24] Ristic S, Strauch RJ, Rosenwasser MP.The assessment and treatment of nerve dysfunction after trauma around the elbow[J]. Clin Orthop Relat Res, 2000, 370:138-153. DOI: 10.1097/00003086-200001000-00013.
相似文献/References:
[1]陈政,付楚杰,彭拓超,等.盐酸纳布啡用于小儿尺桡骨骨折闭合复位克氏针内固定术后镇痛的临床观察[J].临床小儿外科杂志,2019,18(06):503.[doi:10.3969/j.issn.1671-6353.2019.06.013]
Chen Zheng,Fu Chujie,Peng Tuochao,et al.Analgesia of nabulphine hydrochloride after closed reduction and Kirschner wire internal fixation of ulnar and radius fractures in children[J].Journal of Clinical Pediatric Surgery,2019,18(11):503.[doi:10.3969/j.issn.1671-6353.2019.06.013]
备注/Memo
收稿日期:2025-2-11。
基金项目:深圳市医疗卫生三名工程项目(SZSM202011012)
通讯作者:唐盛平,Email:tangshengping56@126.com