尺骨截骨后不行内固定在儿童陈旧性孟氏骨折中应用效果评价

Application effect of ulnar oblique osteotomy followed by no fixation in treatment of obsolete Monteggia fractures in children

目的探讨尺骨截骨后不行内固定在儿童陈旧性孟氏骨折中应用效果。方法 86例陈旧性孟氏骨折患儿依据是否对尺骨进行钢板固定将患儿分为非固定组(n=45)和固定组(n=41),非固定组患儿行尺骨长斜形截骨,桡骨小头复位,跨肱桡关节克氏针固定后,不行尺骨内固定,而固定组患儿则行尺骨钢板内固定。记录两组患儿手术时间及术后尺骨愈合时间,记录两组患儿随访期间并发症发生情况,利用Kim功能评分系统对患儿术后效果进行评估。结果所有患儿术后平均随访时间(17.6±4.5)个月,随访期间,患儿均未出现切口感染,未出现再次脱位,尺骨截骨处愈合良好。非固定组患儿手术时间和尺骨愈合时间均显著短于固定组,差异均有统计学意义(P<0.05);两组患儿术后旋前弧度和屈伸弧度均较术前增加,差异有统计学意义(P<0.05),两组患儿术后旋前弧度、旋后弧度和屈伸弧度差异均无统计学意义(P>0.05);两组患儿术后Kim评分均较术前升高,差异有统计学意义(P<0.05),两组患儿术后Kim评分无差异(P>0.05)。结论单纯行尺骨截骨后不固定应用于陈旧性孟氏骨折患儿,可有效缩短手术操作时间及尺骨愈合时间,避免了行内固定物取出的二次手术创伤,可作为陈旧性孟氏骨折治疗方案。

Objective To investigate the effect of ulnar oblique osteotomy followed by no fixation in treatment of obsolete Monteggia fractures in children. Methods 86 cases of children with obsolete Monteggia fractures were divided into non-fixed group（ n = 45）and fixed group（ n = 41） according to whether ulnas was fixed on the plate. Children in the non-fixed group accepted ulnar oblique osteotomy,radial head reset,and cross brachioradialis joint pinning fixing,but withoutulnar fixation,whereas the fixed group accepted ulna plate fixation. The operation time and postoperative ulna healing time of the two groups were recorded. The occurrences of complications during follow-up of the two groups were recorded as well. The effects after surgery were assessed by using Kim function scoring system. Results The mean follow-up time of all patients were（ 17. 6 ± 4. 5） months. During follow-up,the wounds were not infected,dislocations did not occur again,and ulnar osteotomy healed well. The operation time and ulna healing time of children in non-fixed group were significantly shorter than the fixed group,showing statistically significant differences（ P〈0. 05）. The pronation radians and flexion radians of the two groups after surgery were increased,compared with before surgery,and the differences were statistically significant（ P〈0. 05）. The differences of pronation radians,supination radians and flexion radians between the two groups were not statistically significant（ P〈0. 05）. The Kim scores of the two groups after surgery were increased,compared with before surgery,and the differences were statistically significant（ P〈0. 05）. The differences of Kim scores after surgery between the two groups were not statistically significant（ P〉0. 05）. Conclusions The ulnar oblique osteotomy followed by no fixation in treatment of obsolete Monteggia fractures in children could effectively shorten operation time and ulna healing time,and avoid second surgical trauma for removing fixation. It could be used as an effective treatment for obsolete Monteggia fracture.