HUANG Jin Cheng,LIAN Hong Kai,BAI Yu,et al.Outcome of the ulnar osteotomy plus the fixation of the radial head with a transarticular wire in missed Monteggia fracture[J].Journal of Clinical Pediatric Surgery,2013,12(03):178-180.[doi:10.3969/j.issn.1671—6353.2013.03.004]
尺骨截骨加克氏针固定肱桡关节治疗儿童陈旧性孟氏骨折
- Title:
- Outcome of the ulnar osteotomy plus the fixation of the radial head with a transarticular wire in missed Monteggia fracture
- Keywords:
- Ｆｒａｃｔｕｒｅ; Ｂｏｎｅ／ＳＵ; Ｆｒａｃｔｕｒｅ Fｉｘａｔｉｏｎ; Ｉｎｔｅｒｎａｉ
- 摘要:
- 目的探讨尺骨截骨加克氏针固定肱桡关节治疗儿童陈旧性孟氏骨折的临床疗效。方法回顾性分析本院2008～2012年手术治疗的34例陈旧性孟氏骨折患儿临床资料。34例均采取尺骨截骨加克氏针固定肱桡关节进行治疗。结果34例患儿中，30例获随访，随访时间4~28个月（平均16.9个月）。2例出现桡骨小头再脱位。3例合并桡神经损伤患儿完全恢复。除2例桡骨头再脱位患儿外，所有患儿术后均无疼痛、畸形及活动受限，患侧肘关节屈曲125°～145°（平均132.7°），伸直为45°(平均0°~10°)，旋前范围75°~90°(平均87°)，旋后功能完全恢复。按Kim’s评分标准，24例优秀，2例良好，2例可，2例差。结论尺骨截骨加克氏针固定肱桡关节是治疗儿童陈旧性孟氏骨折的一种有效方法。
- Abstract:
- Objetive To explore the outcome of the ulnar osteotomy plus the fixation of the radial head with a transarticular wire in missed Monteggia fracture.MethodsIn a prospective study，34 patients presented with missed Monteggia fracture were studied. All children underwent ulnar osteotomy plus the fixation of the radial head with a transarticular wire.ResultsThirty patients were followed up for an average duration of 16.9 months (range 4 to28 months). Three patients with the radial nerve injury all get well and another two patients suffered frank dislocation of the radial head. No children except the two who suffered frank dislocation of the radial head complained of pain， deformity and restriction of activity. The mean elbow flexion is 132.7°(range 125°~145°) and mean extension of 4.5° (range 0°~10°).Mean forearm pronation was 87° (range 75°~90°)， and all patients had full supination of 90°.According to the Kim’s criteria，the result was excellent for 24，good for 2，fair for 2， bad for 2.ConclusionThe operation combines of ulnar osteotomy and the fixation of the radial head with a transarticular wire is an effective method to the missed Monteggia fracture．
参考文献/References:
1Bado JL. The Monteggia lesion［J］．Clin Orthop Relat Res，1967，50:71．
2Hui Taek Tim，Byung Guk Park，Jeung Tak Suh，et al．Chronic Radial Head in Children，Part2：Results of Open Treatment and Factors Affecting Final Outcome［J］．Journal of Pediatric Orthopaedics，2002，22:591—597．
3De Boek H. Treatment of chronic radial head dislocation in children［J］．Clin Orthop Rel Res，2000，380:215—219．
4Devnani AS. Missed Monteggia fracture in children［J］．Injury，1997，28:131—133．
5刘云，谢金瑞，李社才．儿童陈旧性孟氏骨折的手术治疗［J］．临床小儿外科杂志，2002，1(1):63—64.
6谢丰，陈柏松，沈阳．尺骨开放延长截骨加桡骨头切开复位治疗儿童陈旧性孟氏骨折［J］．中华小儿外科杂志，2012，33(10):763—765．
7冯阳，黄常红，林清坚，等．尺骨截骨矫形术治疗儿童陈旧性孟氏骨折35例［J］．临床小儿外科杂志，2006，10(5):343—345．
8胡健，邱维胜，胡学富．尺骨截骨治疗儿童陈旧性孟氏骨折［J］．临床骨科杂志，2008，4，11(2):163—165．
9余希，沈先涛，李智超．切开复位、尺或桡骨截骨和重建环状韧带治疗儿童陈旧性孟氏骨折［J］．中华小儿外科杂志，2007，28(11):587—589．
10曾裴，杨建平，任秀智，等．儿童陈旧性孟氏骨折的手术治疗［J］．中华骨科杂志，2012，32(5):457—461．
11Hasler CC， Von Laer L， Hell AK．Open reduction， ulnar osteotomy and external fixation for chronic anterior dislocation of the head of the radius［J］．J Bone Joint Surg Br，2005，87:88—94．
12丁盛，杨彦才，徐振，等．儿童陈旧性孟氏骨折30例临床分析［J］．创伤外科杂志，2013，15(2):171—172．
13Altaf A Kawoosa，Shabir A Dhar，Mohammed Farooq Butt，et al.Stable relocation of the radial head without annular ligament reconstruction using the Ilizarov technique to treat neglected Monteggia fracture: two case reports［J］．J Med Case Reports，2010，10(4): 344．
14Nakmura K， Hirachi K， Uchiyama S， et al. Term clinical and radiographic outcomes after open reduction for missed monteggia fracture-dislocations in children［J］．J Bone Joint Surg Am，2009，91:1394—1404．
15曹志洪，程宁，刘文玲，等．多年小儿陈旧孟氏骨折的治疗体会［J］．中医正骨，2012，24(2):53—54．
16Rahbek O， Deutch Soren R， Kold S， et al. Longterm outcome after ulnar osteotomy for missed Monteggia fracture dislocation in children［J］．J Child Orthop， 2011，5(6): 449—457．
16唐伟，慕明章，谭江威，等．关节囊松解被卡环状韧带下移治疗儿童陈旧性孟氏骨折［J］．中华小儿外科杂志，2011，32(9):682—685．
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