手法整复加外固定治疗孟氏骨折

Treatment of Monteggia' fractures by manipulative reduction and external fixation

目的对孟氏骨折的复位方法、分骨垫的应用及外固定的改进作出分析评定。方法孟氏骨折87例,男71例,女16例。皆采用先整复尺骨骨折,再整复桡骨小头脱位,复位后加用特制的掌背侧双分骨垫,使其稳定不再移位,并对尺桡骨双骨折者,有防骨桥形成的作用。而外固定采用改良式防滑脱超关节夹板固定。复位后以高压氧治疗1～2个疗程(12～24d)。结果随访3～6个月,骨折愈合时间14～60d,平均30d,无桡骨小头再脱位,无尺桡骨间骨桥形成。根据武文臣疗效评价标准优29例,良43例,可13例,差2例。结论对孟氏骨折采取先整复尺骨骨折,再整复桡骨小头脱位,加用特制掌背侧双分骨垫,外以改良式防滑脱超关节夹板固定,是提高疗效的可靠方法。

Objective： To evaluate the method of reposition, the application of bone-separating pad, and the improvement of external fixation for Monteggia＇ fracture. Methods： 87 patients of Monteggi＇a fracture（71 male, 16 female）were treated in the procedure of ulna fracture reduced first,and then the capitulurn of radius. After reduction, bone-separating pad was used on both metacarpal and dorsal sides of forearm to prevent displacement and avoid forming bone-bridage in the case with compound fracture of ulna and radius. The improved preventing sliding splint over bone joint was used as external fixation. After fixation, all the patients were treated by hyperbaric oxygen for two periods（ 12 - 24 d）. Results： The follow-up for 3 to 6 months showed that the mean time of fracture healing was 30 days（ 14 to 60）,and no redislocation and forming of bone bridge were found. According to the standards of evaluation： excellent in 29 cases, good in 43, fair in 13 and poor in 2. The excellent and good rate was 82.7 %. Conclusion： For Monteggia＇ fracture, the fracture of ulna were reduced at first and the eapitulum of radius. Fixation with the metacarpal and dorsal side bone-separating pad and the improved preventing sliding splint over bone joint could enhance the curative effect.