儿童孟氏骨折的治疗

The analysis for the treatment of Monteggia's fracture in children

目的对儿童孟氏骨折的非手术与手术治疗效果进行分析。方法1991年1月～2001年12月,对128例孟氏骨折患儿采用非手术和手术方法进行治疗,男91例,女37例;年龄2～14岁,平均7.4岁。按Bado法分型Ⅰ型(伸展型)73例,占57.0%;Ⅱ型(屈曲型)20例,占15.6%;Ⅲ型(内收型)33例,占25.8%;Ⅳ型(尺桡骨双骨折合并桡骨头脱位)2例,占1.6%。非手术治疗50例,均为1周内的新鲜骨折;手术治疗78例,包括闭合复位失败的新鲜骨折30例及陈旧性骨折48例。非手术组患儿均行手法复位,石膏固定;手术组患儿中,45例采用单针固定(新鲜骨折16例,陈旧性骨折29例),即肱桡关节复位后,单枚克氏针固定,尺骨骨折复位后不做内固定;33例采用双针固定(新鲜骨折14例,陈旧性骨折19例),即复位肱桡关节及尺骨骨折后,分别用克氏针固定。手术组中,新鲜骨折环状韧带可行简单修补,但不需重建;陈旧性骨折不行环状韧带修复或重建,手术组术后均行石膏固定4～6周。结果128例患儿均获得随访,随访时间1～10年,平均5.6年。根据李汉民等制定的标准对患儿肢体功能进行评定。非手术组优42例,良4例,一般2例,差2例,优良率92.0%;单针固定组优37例,良5例,一般2例,差1例,优良率93.3%;双针固定组优22例,良7例,一般2例,差2例,优良率87.9%。结论儿童新鲜孟氏骨折治疗应首选闭合复位,

Objective To analyze the clinical outcomes after different treatments for the Monteggia's fracture in children. Methods From January 1991 to December 2001, a total of 128 children with Monteggia's fracture were reviewed, there were 91 males and 37 females, the average age was 7.4 years (range, 2-14 years). According to the Bado classification system: 73 of typeⅠ( extension type) accounted for 57.0%; 20 of type Ⅱ (flexion type), 15.6%; 33 of type Ⅲ (adduction type), 25.8%; 2 of type Ⅳ, 1.6%. 50 patients received conservative treatment, all belonged to the fresh fractures (within 1 week after injury); the other 78 patients were operated, including 30 fresh fractures after failure of closed reduction and 48 old fractures. The conservative patients received manipulation and plaster immobilization. In the operative group, 45 patients (16 fresh and 29 old fractures) were fixed with single Kirschner wire after reduction of the radiohumeral joints, and the ulnas were free of fixation; 33 children (14 fresh and 19 old fractures) were fixed with double wire both for the radiohumeral joints and fractured ulnas. In the fresh Monteggia's fractures, the annular ligament was repaired simply without reconstruction, but in the old fractures, neither reparation nor reconstruction was needed. The plaster was kept for 4-6 weeks postoperatively. Results All patients were available at the final follow up with a mean of 5.6 years (range, 1-10 years). According to the Lihan Ming's scoring system for the motion function in children: the conservative patients were classified as 42 excellent, 4 good, 2 fair and 2 poor, the excellent and good rate was 92%; and in the single wire group, there were 31 excellent, 5 good, 2 fair and 1 poor, the excellent and good rate was 93.3%; finally in the double wire group, 22 excellent, 7 good, 2 fair and 2 poor, the excellent and good rate was 87.9%. Conclusion The closed reduction should be selected first for the fresh Monteggia's fracture in children, the operation is only indicated for the special fresh or old fractures, in which neither the anatomic reduction was satisfactory nor the reduction can be kept without internal fixation. The operative technique, including the open reduction of the radiohumeral joint and fixation both with Kirschner wire and plaster,is reliable to improve the clinical results.