成人孟氏骨折脱位分型与预后的关系

The relationship between the classification of the Monteggia dislocation-fracture in adult and its prognosis

目的探讨成人孟氏骨折脱位的Bado分型与预后的关系。方法自1994年1月至2004年1月,对获得随访的60例成人孟氏骨折脱位患者的临床资料进行分析,男41例,女19例;平均年龄为29岁(14～54岁)。其中BadoⅠ型骨折脱位26例,BadoⅡ型骨折脱位14例,BadoⅢ型骨折脱位19例,BadoⅣ型骨折脱位1例。尺骨骨折采用切开复位钢板螺钉内固定,桡骨头骨折采用切开复位内固定或桡骨头部分、全部切除术。不合并骨折的桡骨头脱位大多行闭合复位石膏固定,合并桡神经损伤者未行手术探查。统计学研究采用非典型数据统计分析系统(NoSA)的秩和检验。结果术后随访12～72个月,平均24个月。按Broberg和Morrey评分系统,BadoⅠ型,24例评分为满意,2例不满意,满意率为92%;BadoⅡ型,10例满意,4例不满意,满意率为71%;BadoⅢ型19例,结果均为满意(100%),1例BadoⅣ骨折脱位结果满意。统计学检验各组在骨折预后方面差异无统计学意义。合并桡骨头骨折组与未合并桡骨头骨折组之间,患者的预后差异有统计学意义。结论Bado分型对于骨折的预后没有指导意义。在成人孟氏骨折中,是否合并桡骨头骨折对治疗结果影响较大。

Objective To study the relationship between the Bado＇s classification of the Monteggia fracture in adult and their prognosis. Methods Studying the 60 patients in our hospital suffering from Monteggia fracture-dislocation during 10 years between 1994 to 2004, and their clinical data of the follow-up is analysised with statistics. There were 26 cases with Bado type Ⅰ fracture-dislocations, 14 cases with Bado type Ⅱ fracture-dislocations, 19 cases with Bado type Ⅲ and 1 case with Bado type 1V fracture-dislocations. The fractures of the shaft of the ulna were treated operatively with open reduction and internal fixation using plates and screws. The fractures of the radial head were operated with open reduction and internal fixation, or are treated with the resection of the partial or total radial head. For the cases of the dislocation of the radial head without fracture, the most commonly used treatment method was to reduce the dislocation closely and stable the position with external fixation by a plaster cast. For the injury of the radial nerve associated with the Monteggia fracture dislocation, no operation had been done to make an exploration. Rank Sun Test of NoSA system was adopted to analysis the clinical data gained above. Results The average duration of the follow-up was 24 months （12-72 months）. The results were graded according to the score system of Broberg and Morrey. In Bado type Ⅰ , 24 cases were considered satisfactory and 2 cases unsatisfactory, satisfactory ratio is 92%; In Bado type Ⅱ, 10 cases satisfactory and 4 cases unsatisfactory, satisfactory ratio was 71%; In Bado type Ⅲ and type Ⅳ, all the cases gained satisfactory results, satisfactory ratio was 100%. Rank Sun Test showed there was no obvious difference on prognosis between every group of the Bado＇s classification system. But statistical obvious difference could be found between the group with the fractures of the radial head and the group without. Conclusion The classification system of Bado has no prediction prognosis. In adult Monteggia fracture, the final result largely depends on whether there is a fracture of the radial head.