成人尺骨近端向后孟氏损伤的诊断与治疗

Posterior monteggia fracture-dislocations of proximal ulna

目的探讨成人尺骨近端向后孟氏损伤的诊断、鉴别诊断及治疗策略。方法2004年4月至2007年12月共手术治疗16例成人尺骨近端向后孟氏损伤患者，其中对13例患者获得随访，随访时间12～58个月，平均28个月。手术均采用肘关节后正中人路。术中尽量对桡骨头骨折和冠状突骨折进行复位和固定。对尺骨近端的固定，7例采用单纯钢板，2例钢板加克氏针，3例钢板加克氏针张力带，1例克氏针张力带加螺钉。结果末次随访时均无明显疼痛及肘关节不稳定。患肢肘关节伸屈活动范围平均为100°（0°-145°），前臂旋转活动范围平均为119°（0°～170°）。Mayo肘关节功能评分（MEPS评分）平均为93．1分（67～100分），优良率92．3％。Broberg—Morrey评分平均为88．8分（53～100分），优良率76．9％。结论对尺骨近端向后孟氏损伤要注意正确的诊断与鉴别诊断。手术治疗的关键要重建尺骨近端长度和对线，尽量对其进行解剖复位并牢固固定。

Objectives To discuss the diagnosis and differential diagnosis, and to establish an effective protocol to treat the posterior Monteggia fracture-dislocations of proximal ulna in adult according to our experience. Methods Between April 2004 and December 2007, 16 patients with posterior Monteggia fracture-dislocations were treated surgically, 13 were followed up at a mean of 28 months （range, 12-58 months）. All the operations were through the posterior midline approach. The fractures of radial head and coronoid process were reduced and fixed, if possible. The proximal ulna fractures were fixed with a single plate in 7cases, plate combined with K-wires in 2, plate combined with K-wires tension band in 3, and K-wires tension band combined with screws in 1. Results No elbow was painful or unstable at the last follow up examination. They had an average of 100°（range, 0° to 145°） of flexion-extension of elbow. The average motion of forearm rotation was 119° （range, 0° to 170°）. The mean Mayo Elbow Performance Score （MEPS）was 93.1 points（67-100 points）, excellent and good results were achieved in 92. 3%. The mean system of Broberg and Morrey score was 88.8 points （ 53-100 points ）, excellent and good results were achieved in 76.9%. Conclusions Attention should be payed to the diagnosis and differential diagnosis of the posterior Monteggia fracture-dislocation of proximal ulna. Anatomically reduction and stable fixation of proximal ulna is the keystone for the surgical treatment.