儿童孟氏骨折环状韧带损伤后急性期修补和重建的临床效果评价

The Evaluation on Clinical Results in Acute Children＇s Monteggia Fracture with Annular Ligament Repaired or Reconstruction

目的：对儿童孟氏骨折环状韧带损伤后于急性期修补和前臂筋膜重建两种不同治疗方法的临床效果进行评价，探讨影响孟氏骨折预后的因素。方法回顾分析2008年06月～2013年09月住院的43例因环状韧带损伤而致闭合复位失败的急性期儿童孟氏骨折，随机分成2组，行切开手术治疗，尺桡骨复位固定，22例作环状韧带原位修补（环状韧带原位修补组），21例以前臂深筋膜条重建环状韧带（环状韧带重建组）。随访测量患侧肘关节屈伸/旋转活动范围，并测出对侧正常肘关节屈伸/旋转活动范围，作运动功能得分（motion score），2组间进行比较。结果所有病例经6个月～5年9个月（平均2.9年）随访，环状韧带原位修补组肘关节屈伸、旋转活动功能及运动得分均优于环状韧带重建组（P＜0.05）。结论儿童孟氏骨折急性期如因环状韧带损伤而致闭合复位失败，应尽量行环状韧带原位修补，如无法修补，用前臂深筋膜代替环状韧带，仍能期望良好的治疗效果。

Objective To evaluate the clinical outcome in acute children＂s Monteggia fracture after annular ligament repaired or reconstruction and to inquire into the factors affecting prognosis of Monteggia fracture. Methods A retrospective study for 43 patients of acute Monteggia＂s fractures in children, who were hospitalized in our hospital from June 2008 to September 2013, failed in conservative treatment. Two groups were formed by random assignment, underwent operation for ulnar fracture reduction and fixation, 22 cases were treated by annular ligament repaired and 21 cases underwent annular ligament reconstruction with the deep forearm fascia. We measured the injured elbow flexion and extension/rotation range, and measured the activities of the contralateral normal elbow flexion and extension/rotation range during follow-up. The motion score of each patient was calculated and compared between two groups. Results All patients were followed-up for 6 months to 5 years 9 months （average 2.9 years）, the elbow motion range and the motion score of annular ligament repaired group is larger than the annular ligament reconstruction group （P〈0.05）. Conclusion The acute Monteggia＂s fracture in children with annular ligament damaged should be treated by annular ligament repaired. However, when it is difficult to repaired, to replace the annular ligament with a forearm deep fascia can still expect good results.