儿童孟氏骨折的分型及治疗

Classification and Treatment of Monteggia fracture in Children

目的 探讨儿童孟氏骨折的诊断分型及个性化治疗措施 ,观察不同治疗措施的疗效。方法 复习我院自1 992年至 2 0 0 2年间治疗的 67例儿童孟氏骨折的临床资料 ,对其进行Bado分类 ,其中 2 9例 (A组 ,Ⅰ型 2 1例 ,Ⅱ型 6例 ,Ⅲ型 2例 )采用手法复位石膏外固定、38例 (B组 ,Ⅰ型 2 2例 ,Ⅱ型 6例 ,Ⅲ型 7例 ,Ⅳ型 3例 )开放复位内固定环状韧带重建治疗 ,对两组的肘关节及前臂的功能进行分析 ,比较两组的疗效。结果 随访时间 7个月～ 9年 ,平均 5年 1个月 ,A组 2 9例中 ,优良 2 6例 ,差 3例 ;B组 38例中 ,优良 35例 ,差 3例 ,P >0 .0 5 ,两组的总体优良率差异无显著性。结论 对孟氏骨折明确分型十分必要。针对不同类型的骨折脱位采用合适的治疗方式 。

Objective To discuss the classification,diagnosis and special treatment of Monteggia fracture in Children,and observe the effect of different therapy.Methods The clinical data of 67 Monteggia fracture in Children during 1992 to 2002 were reviewed,then were classified through Bado criteria.29 cases(Group A,Type Ⅰ:21 cases,Ⅱ:6 cases,Ⅲ:2 cases)were treated by plaster-splint after manual reduction;38 cases(Group B,Type Ⅰ:22 cases,Ⅱ:6 cases,Ⅲ:7 cases,Ⅳ:3 cases) were treated by internal fixation and annular ligament reconstruction.The function of forearm and elbow of two groups were evaluated.Results All patients were followed up 7 months to 9 years,5.1 years on average.In group A,26 cases were rated as excellent and good,3 poor;In group B,35 cases were rated as excellent and good,3 poor.P>0.05,there were no difference on the rate of excellent and good between two groups.Conclusion The classification of Monteggia fracture-dislocation is very necessary.The suitable selection including manual reduction or intrnal fixation to different type fractures can improve the effect of treatment.