成人Monteggia骨折48例临床分析

Monteggia fractures in adults： Review of 48 cases

目的回顾性分析成人Monteggia骨折的手术疗效。方法1994年9月—2007年1月，对48例成人Monteggia骨折，按Bado和B0yd分型，其中Ⅰ型22例，Ⅱ型17例，Ⅲ型6例，Ⅳ型3例；其中26例（占54．2％）患者合并全身多发损伤，8例合并桡／正中／尺神经损伤。44例行尺骨切开复位／截骨矫形内固定，其中选用3．5mm LC-DCP固定12例，3．5mm重建板19例，张力带8例（经鹰嘴骨折），1／3管型钢板5例；4例行闭合复位克氏针固定。桡骨头脱位均在X线机透视下先行手法复位，对37例复位失败者采用切开复位，其中17例行环状韧带修补或重建，4例行桡骨头部分或完全切除。结果术后随访时间为6—26个月，平均17个月。根据Broberg和Morrey评分系统评定：本组平均得分为84．2（31—100），其中优17例（占35．4％），良15例（占31．3％），可9例（占18．8％），差7例（占14．6％）。疗效可或差16例中，9例为Ⅱ型损伤伴有桡骨头或桡骨颈骨折。术前8例和术后6例合并神经损伤患者均恢复了手部功能。结论成人Monteggia骨折并发症对预后影响较大。虽然多数患者可取得满意的关节功能，但需重视早期并发症的出现。

Objective To review the surgical treatment outcomes of Monteggia fractures in adults. Methods From September 1994 to January 2007, 48 patients with Monteggia fracture were treated in our hospital. The average age was 36.4 years （ 18 -66 years）. Aecording to the classifieation of Bado, there were 22 cases of type Ⅰ, 17 cases of type Ⅱ, 6 cases of type Ⅲ and 3 cases of type Ⅳ fractures. In 54.2% of the patients, the lesions were associated with multiple traumas. Eight cases had radial/median/ulnar nerve injuries. In 44 cases, treatment consisted of open reduction or osteotomy and internal fixation of the ulnar fracture using different methods of osteosynthesis （3.5 mm DCP, 3.5 mm reconstruction plates, tension band technique with Kirschner wires, and one-third tubular plates）. Initial treatment of the radial head dislocation was attempted by closed reduction under fluoroscopy monitoring. Subsequent open reduction was performed in 37 eases after failed close reduction. Four of these cases underwent annular ligament repair or reconstruction. Four had partial or complete resection of the radial head. There were seven open fractures with one c~ developing chronic infection. Results The average follow-up was 17 months （6 -26 months）. At the most recent follow-up examination, the average score, according to the system of Breberg and Morrey, was 84. 2 points （range, 31 to 100 points）. The result was excellent for 17 patients, good for 15, fair for 9, and poor for 7. Nine of the 16 patients who had an unsatisfactory （fair or poor） result had had a Bado type-II fracture with a concomitant fracture of the radial head. Recovery of hand function was observed in 8 cases that had concomitant nerve injury and 6 cases that suffered nerve injury due to close reduction. Conclusion Monteggia fractures in adults are fraught with complications despite good functional results in the majority of cases. The patient should be informed early on of the risks of residual functional deficits and the need for further surgical intervention.