Monteggia骨折固定方法的选择体会

How to select appropriate methods to fix Monteggia fractures

目的:Monteggia骨折是一种复合型损伤,治疗不当易引起并发症,分析如何选择适当的固定方法以取得好的疗效。方法:根据尺骨骨折的情况采取不同的方法进行固定:手法整复并石膏固定的方法治疗20例儿童青枝骨折或无明显移位的横断骨折;手法整复并克氏针闭合穿针治疗13例手法复位石膏固定失败及尺骨横断移位性骨折;切开复位克氏针或钢板螺钉固定25例尺骨粉碎性、斜形或螺旋形骨折,其中2例行环状韧带重建。结果:全部骨折均良好愈合,经半年随访,优47例,占81.0％;良9例,占15.5％;差2例,占3.5％。结论:尺骨骨折准确复位可靠固定是恢复上尺桡关节正常解剖关系以取得良好疗效的关键,因此应根据尺骨骨折线及移位情况选择合适的固定方法:青枝骨折多可手法整复后石膏固定,若固定失败可用克氏针闭合穿针固定,横断骨折无严重移位时也可采用该方法,对于斜形,粉碎性等不稳定性骨折应采用切开复位内固定的可靠方法。

Purpose: To study how to select appropriate methods to fix Monteggia lesions.Methods:58 cases of Monteggia lesions were treated by different fixating methods according to the the type of the ulnar fractures. 20 cases of greenstick fractures in children by manual reduction and followed by plaster immobilisation, 13 cases of transverse or green-stick fractures failing to plaster fixation by manual reduction and closed intramedullary nailing,25 cases of comminuted or oblique ones by K-wire or plate and screw internal fixation. Results:47 cases (81.0%) had excellent results and 9 cases (15.5%) got good, the reasons of 2 patients (3.5%) with poor outcomes were not technique problems. Conclusion:In order to receive perfect results, we must reduct ulnar fractures anatomically and fix reliably to provide stable reduction of proximal radio -- ulnar jionts.