小儿孟氏骨折脱位扣眼畸形的病理认识以及环状韧带重建术的探讨

Pathology of buttonhole deformity of Monteggia fracture-dislocation and suitability of reconstructive surgery of anular ligaments

目的 对小儿孟氏骨折脱位及陈旧性孟氏骨折的传统治疗方法、创伤病理解剖、治疗结果及发生漏诊、误诊、误治的病例进行研究。以找到解决问题的方法 ,提高疗效。方法 对 170例孟氏骨折脱位患儿的致病原因、治疗方法、术中所见、手术方式以及治疗效果等进行研究、分析。结果 83例中 ,优 5 9例 ,良 15例 ,一般 9例 ,差 5例。结论 ①孟氏骨折脱位的定义应为 :尺骨干骨折合并桡 肱及桡 尺脱位 ,合并 /或不合并桡骨上 1/ 3骨折、桡骨颈骨折、桡骨头骨折脱位 ;②尺骨鹰嘴骨折合并肘关节脱位不应诊断为孟氏骨折 ;③提出“超伸直型”孟氏骨折的概念 ;④尺骨骨折的稳妥治疗及坚强内固定是治疗孟氏骨折的关键 ;⑤桡骨颈骨折既要对位好 ,更要对线好 ,以免以后发生旋转障碍 ;⑥急诊患儿可行环状韧带修补术及关节囊紧缩术 ,晚期患儿应行关节囊紧缩术 。

Objective To establish better treatment for Monteggia fracture by studying the traditional management, traumatic anatomy, treatment efficacy, and misdiagnosed cases of Monteggia fracture dislocation and old Monteggia fracture in children. Methods 170 children with Monteggia fracture dislocation were examined in terms of causes, treatment, intraoperative findings, operational techniques and efficacy etc. Results Of 83 cases treated, the results were excellent in 59, good in 15, fair in 9 and poor in 5. Conclusions (1) The Monteggia fracture dislocation should be defined as fracture of ulna combined with radiohumeral and radioulnar dislocation, with or without dislocation of fracture of upper one third, neck of radius, and head of radius. (2) The Monteggia fracture should not cover fracture of ulnar olecranon combined with elbow dislocation. (3) A 'super straight type'Monteggie fracture concept was proposed. (4) The careful treatment of fracture of ulna and firm internal fixation are the keys of treatment of Monteggia fracture. (5) For the treatment of fracture of neck of radius, linear as well as positional alignment should be achieved to avoid later development of rotation disorder. (6) For emergency cases of juvenile Monteggia fracture, repair of anular ligaments can be performed and reefing of joint capsule can be done for late stage cases. Reconstruction of anular ligaments is not recommended.