成人Monteggia骨折的手术效果观察

Operation effect observation of adult Monteggia fracture

目的:对成人Monteggia骨折的手术效果进行观察分析。方法:28例Monteggia骨折患者均采用手法复位,若失败则行切开复位术,对环状韧带进行修补或切除、重建,然后实施骨折解剖复位,采用加压钢板对尺桡骨或尺骨实施固定,桡骨小头陈旧性脱位的切除桡骨头。术后采用石膏托对患肢进行屈肘固定8～11 d,实施前臂旋前、旋后的主动活动以及肘关节的主动轻柔屈伸,术后6周对前臂及肘部实施功能性锻炼。对桡神经损伤患者进行神经营养药物治疗。结果:术中7例桡骨头合闭复位不成功,3例环状韧带切除、重建,4例实施了环状韧带修补,其中,1例修补后旋转受限。5例桡神经损伤患者经药物治疗后功能均恢复。28例疗效依据Morrey和Borberg评估标准进行评定,其中,优16例,良10例,可1例,差1例,优良率达92.86%(26/28)。结论:通过对桡骨的复位以及骨折部位的加压钢板内固定治疗成人Monteggia骨折效果良好。

Objective：To observe and analyze the operation effects of adult Monteggia fracture.Methods：Manipulative reduction was adopted in 28 cases of patients and open reduction was adopted after the failure of manipulative reduction,repair or resection and reconstruction of annular ligament,then anatomical reduction was implemented.Compression plate fix of the ulna and radius or ulna was adopted.Radial head resection was implemented in patients with old dislocation of radial head.Postoperative plaster was used to fix the sick limb with elbow flexion for 8-11 days,active movement of forearm pronation and supination and active gentle flexion and extension of elbow were implemented.After 6 weeks functional exercise of forearm and elbow was implemented and radial nerve injury was treated with neurotrophic drugs.Results：Radial head closed reduction was unsuccessful in 7 cases,3 cases had resection and reconstruction of annular ligament,repair operation of annular ligament was implemented in 4 cases,and 1 case had rotational restriction after operation.5 cases of patients with radial nerve injury were all cured after drug treatment.The evaluation of 28 cases according to Morrey and Borberg evaluation criteria showed that 16 cases were excellent,10 cases were good,1 case was fair and 1 case was poor,the excellent and good rate was 92.86%（26/28）.Conclusion：The effect of radial bone reduction and fracture site compression plate fixation in the treatment of Monteggia fracture is good.