儿童Monteggia′s骨折的治疗选择

Choice for the treatment of Monteggia′s fracture in children

摘要：[目的]探讨儿童Monteggia＇s骨折的治疗方法及效果。[方法]本组患儿66例，男47例，女19例，其中新鲜骨折61例，陈旧性骨折5例。按Bado分型：Ⅰ型46例，Ⅱ型4例，Ⅲ型15例，Ⅳ型1例。采用非手术和手术治疗方法，对患儿进行针对性的个体化治疗。非手术治疗行手法复位、石膏固定，手术治疗则是在手法复位成功后，分别采用单针固定尺骨或肱桡关节、双针固定尺骨和肱桡关节，再行石膏固定，手术中均未修复或重建环状韧带。[结果]66例患儿在门诊获得6个月～5年的随访，参照李汉民等制定的评定标准，非手术组的优良率为95．7％，手术组的优良率为84．2％。未发生骨化性肌炎、骨间背侧神经损伤、尺桡骨骨性连接、尺骨骨不连、迟发性桡骨小头脱位等并发症，合并神经损伤的患儿术后2～4个月均完全恢复。[结论]儿童Monteggia＇s骨折的治疗效果优良，治疗的关键在于应争取在急诊下复位，并根据骨折类型及肱桡关节的复位情况，采用针对性的内固定措施以防止骨折移位及再脱位的发生，防止漏诊。

[ Objective ] To discuss the clinical results and treatments of the Monteggia＇s fracture in children. [ Method ] Total of 66 patients including 61 fresh and 5 old fractures were reviewed. There were 47 males and 19 females. According to the Bado classification system ： 46 of type Ⅰ ,4 of type Ⅱ , 15 of type Ⅲ, 1 of type Ⅳ, all patients received conservative or operatire treatment. The conservatively treated patients received manipulation and plaster immobilization. In the operative group, the patients were fixed with single or/and double Kirschner＇s wires after reduction of the radiohumeral joints or/and fractured ulna. Neither reparation nor reconstruction was needed. [ Result] All patients were available at the final follow up with 0.5 -5 years. According to the Li Hanmin＇s scoring system for the motion function in children： excellent and good rate was 95.7% in conservative group and 84.2% in operative group. There was no complication such as myositis ossificans, synostosis of radius and ulna, ulna nonunion,radial head dislocation and profundus radial nerve injury. The cases of nerve injury were complete recovered after operation two or four months later. [ Conclusion] The clinical results of the Monteggia＇s fracture in children was very good with immediate reduction and internal fixation in proper cases, a good overall therapeutic outcome can be expected in children with Monteggia＇s fracture, h is very important to prevent missed diagnosis.