两种手术方式治疗儿童新鲜孟氏骨折的效果分析

Analysis of curative effects of two kinds of surgical treatment for fresh Monteggia fracture in children

目的探讨两种手术方式治疗儿童新鲜孟氏骨折的效果。方法研究分析14例新鲜孟氏骨折患儿的临床资料。将14例新鲜孟氏骨折患儿随机分成A、B组,各7例,A组患者采用单枚克氏针固定肱桡关节加尺骨切开复位钢板内固定治疗,B组患者只采用尺骨切开复位钢板内固定治疗。结果术后随访6~24个月(平均12个月)。所有患儿均无切口感染、尺骨不愈合、骨化性肌炎。两组患儿术后肘关节伸屈和前臂旋前、旋后活动度差异无统计学意义(P>0.05)。根据Mackay疗效评定标准:A组优6例,良1例,B组优5例,良2例。B组出现2例术后桡骨小头脱位,行翻修手术后愈合佳。结论两种手术方式治疗后肘关节伸屈及前臂旋转活动度恢复佳,均可作为治疗儿童新鲜孟氏骨折的首选方法,而利用克氏针固定肱桡关节可更好地预防术后桡骨小头脱位。

Objective To investigate the effects of two kinds of surgical treatment for fresh Monteggia fracture in children.Methods The clinical data of 14 children with fresh Monteggia fracture were collected and analyzed.14 cases of fresh Monteggia fracture were randomly divided into group A and B, 7 cases in each group.Group A was treated with single Kirschner wire fixation of humeroradial joint with internal fixation, and group B was treated with open reduction and plate fixation.Results Patients were followed up for 6-24 months （average 12 months）.All patients had no wound infection, nonunion of ulna, myositis ossificans.There was no significant difference in the elbow flexion and extension, pronation and supination of the forearm between the two groups （P〉0.05）.According to the Mackay standard： 6 cases were excellent and 1 case was good in group A, while 5 cases were excellent and 2 cases were good in group B.Radial head dislocation occurred in 2 patients of group B, and they had a good healing after revision surgery.Conclusion Range of motion of elbow and forearm in children with fresh Monteggia fracture is restored well through two kinds of surgery treatment which could be the first method of fresh Monteggia fracture, and the use of Kirschner wire in the fixation of humeroradial joint can better prevent postoperative dislocation of the radial head.