儿童类孟氏骨折的分型与治疗

CLASSIFICATION AND TREATMENT OF MONTEGGIA EQUIVALENT FRACTURES IN CHILDREN

目的探讨儿童类孟氏骨折的分型标准及手术治疗方法和疗效。方法回顾性分析2008年1月-2012年1月收治的35例类孟氏骨折患儿临床资料。男17例,女18例;年龄1岁2个月~14岁11个月,平均7岁5个月。致伤原因:跌伤25例,摔伤3例,运动伤7例。受伤至入院时间1 h^16 d,中位时间28 h。根据自定义骨折分型标准:Ⅰ型为尺骨骨折(包括鹰嘴)伴桡骨颈骨折或桡骨近端骨骺损伤,22例;Ⅱ型为肘关节后脱位伴桡骨颈骨折或桡骨近端骨骺损伤,2例;Ⅲ型为尺骨和/或鹰嘴骨折伴肱骨外髁骨折,10例;Ⅳ型为尺、桡骨骨折伴桡骨颈骨折或桡骨近端骨骺损伤,1例。根据分型结果,对骨折复位后行内固定或辅助石膏外固定。结果术后患儿切口均Ⅰ期愈合,无切口感染等并发症发生。34例患儿获随访,随访时间12~18个月,平均14个月。X线片复查示,骨折均愈合,骨折愈合时间6周~5个月,平均2.5个月。末次随访时,采用改良肘关节美国特种外科医院(HSS)评分评价疗效,获优29例,良4例,可2例,优良率达94%。无肘内、外翻及迟发性尺神经炎等并发症发生。结论与传统分型标准相比,自定义分型标准简单易记,有利于减少漏诊率及选择治疗方法;手术是治疗儿童类孟氏骨折的有效方法。

Objective To investigate the classification and treatment of Monteggia equivalent fractures in children. Methods A retrospective analysis was made on the clinical data of 35 cases of Monteggia equivalent fractures between January 2008 and January 2012. There were 17 boys and 18 girls with an average age of 7 years and 5 months （range, 1 year and 2 months to 14 years and 11 months）. The causes of injury were tumbling injury in 25 cases, falling injury in 3 cases, and sport injury in 7 cases. The disease duration from injuries to admission ranged from 1 hour to 16 days （median, 28 hours）. According to the criteria of self-made classification, there were 22 cases of type I （ulnar fracture with radial neck fracture or proximal radial epiphysis injury）, 2 cases of type II （posterior elbow dislocation with radial neck fracture or proximal radial epiphysis injury）, 10 cases of type III （ulnar fracture and/or olecranon fracture with humeral lateral condylar fracture）, and 1 case of type IV （fractures of radius and ulna with radial neck fracture or proximal radial epiphysis injury）. All patients were treated by open reduction and internal fixation/external fixation. Results All incisions healed by first intention without infection. Thirty-four cases were followed up 14 months on average （range, 12-18 months）. All fractures healed at 2.5 months on average （range, 6 weeks to 5 months）. According to Hospital for Special Surgery （HSS） score system, the results were excellent in 29 cases, good in 4 cases, and fair in 2 cases, with an excellent and good rate of 94%. No cubit varus/valgus or delayed ulnar nerve injury was observed. Conclusion New self-made classification is simple and easy to remember, and it is helpful to reduce omission diagnose rate and select therapeutic methods. Surgery is an effective method to treat Monteggia equivalent fractures.