尺骨截骨后不行内固定与钢板内固定治疗儿童陈旧性孟氏骨折的疗效比较

Ulnar oblique osteotomy followed by plating versus no plating in treatment of obsolete Monteggia fractures in children

目的比较尺骨截骨后不行内固定与钢板内固定治疗儿童陈旧性孟氏骨折的疗效。方法回顾性分析2001年1月至2011年6月收治的33例陈旧性孟氏骨折患者资料，男23例，女10例；年龄4～13岁，平均8．1岁；骨折按Bado分型：I型23例，Ⅱ型4例，Ⅲ型6例。所有患者均采用长斜形截骨拉伸延长尺骨，根据有无应用钢板固定尺骨将患者分为未固定组（复位桡骨小头后，跨肱桡关节行克氏针固定，尺骨不行内固定）17例和固定组（采用跨肱桡关节克氏针固定＋尺骨钢板内固定）16例。通过尺骨截骨后愈合时间和术后Mackay肘关节功能评定标准评定疗效。两组患者术前一般资料比较差异无统计学意义（P〉0．05），具有可比性。结果33例患者术后获1．5年（10个月至3年）随访，均未发生切口感染，尺骨截骨处均获愈合。未固定组尺骨平均愈合时间[（7．2±1．1）周】短于固定组[（8．5±1．8）周]，差异有统计学意义（P〈0．05）。根据Mackay肘关节功能评定标准评定疗效：未固定组：优10例，良5例，差2例；固定组：优11例，良4例，差1例。两组各有3例患者仍在肘关节活动时残留轻度疼痛；未固定组1例患者去除肱桡关节克氏针后桡骨小头再次脱位。结论儿童陈旧性孟氏骨折尺骨截骨后不行内固定有创伤小、避免对尺骨血供的进一步破坏、手术时间短、骨折愈合时间短和避免二次手术取出内固定物等优点。

Objective To compare the clinical efficacy of plating versus non-plating following ulnar oblique osteotomy in the treatment of obsolete Monteggia fractures in children. Methods Clinical data of 33 patients were reviewed who had been treated for obsolete Monteggia fracture in our department from January 2001 to June 2011. They were 23 males and 10 females, aged from 4 to 13 years （average, 8. 1 years） . According to the Bado classification, 23 cases were type I, 4 type 11 and 6 type 111. Ulnar oblique osteotomy was performed in all the 33 cases to extend the ulna lengthways, but their subsequent fixation was different. In the non-plating group （17 cases）, after reduction of the radial head, a supplementary transfixation of the ra- dius was performed with a Kirschner wire through the capitellum, and the excised ulna was free of fixation. In the plating group （16 cases）, after transfixation of the radius with a Kirschner wire through the capitellum, plating was performed of the excised ulna. Both groups were immobilized in a plaster cast after surgery. The 2 groups were compared with respect to healing time for the ulnar osteotomy and the Mackay scoring for postoperative elbow function. The 2 groups were comparable with no significant difference in the general data （ P 〉 0.05） . Results Follow-ups for an average of 1.5 years （from 10 months to 3 years） re- vealed no incision infection and ulnar healing in all the patients. The average ulnar healing time for the non-plating group （7.2 -＋ 1.1 weeks） was significantly shorter than for the plating group （8.5 ＋ 1.8 weeks） （P 〈 0. 05）. In the non-plating group, 10 cases were rated as excellent, 5 good and 2 poor; in the plating group, 11 cases were rated as excellent, 4 good and one poor. In either of the 2 groups, 3 cases reported residual pain in elbow motion. The non-plating group reported one case of dislocation of the capitellum. Conclusion Non-plating after ulnar osteotomy may be used as a treatment of obsolete Monteggia fractures in children, because it has advantages of less invasion to the ulnar blood supply, shortened operation time and healing time.