尺骨截骨矫形关节囊松解紧缩治疗儿童陈旧性孟氏骨折

Ulna osteotomy and joint capsule release and tight for old Monteggia's fracture in children

目的 :探讨儿童陈旧性孟氏骨折的手术治疗经验及治疗效果。方法 :自2013年1月至2017年12月治疗32例陈旧性孟氏骨折,男18例,女14例;年龄2~9(5.3±1.2)岁;均无桡神经损伤症状。患者术前症状为肘关节疼痛、畸形,屈伸及前臂旋转受限,X线示尺骨畸形愈合或呈"弓形征",桡骨头脱位或半脱位。术中作尺骨脊后方切口,在尺骨成角畸形最明显处行额状面长斜形截骨,然后采用Boyd切口显露肱桡关节及上尺桡关节,清理关节内的瘢痕组织,复位桡骨头,并在维持肘关节稳定的前提下,对尺骨截骨处进行处理,予钢板螺钉内固定。结果:32例患儿均随访,时间12~24个月,平均14.8个月,其中1例患儿出现术口感染。根据Mackay评定标准:32例患儿术后均无肘、腕关节疼痛症状,29例患儿肘关节屈伸活动度(130±5)°/0°,前臂旋前旋后活动度90°/(85±5)°;2例患儿肘关节屈伸活动度(119°/8°,121°/7°),前臂旋前旋后活动度(90°/75°,85°/60°);1例患者肘关节屈伸活动度90°/10°,前臂旋前旋后活动度80°/60°。优29例,良2例,中1例。结论:尺骨截骨矫形、肘关节后关节囊松解、前关节囊紧缩是治疗儿童陈旧性孟氏骨折的有效方法。

Objective ：To explore the experience and effect of surgical treatment in old Monteggia fracture in children. Methods：From January 2013 to December 2017,32 cases of old Monteggia＇s fi＇acture were treated including 18 males and 14 females with an average age of （5.3±1.2） years old ranging from 2 to 9 years old. No symptonls of radial nerve injury were found. The preoperative symptoms of the patients were the pain and deformity of the elbow joint, the flexion and extension and the limited forearm rotation. The X-ray showed the union of the ulna or the ＂arched sign＂ ,the dislocation of the radial head or the subluxation of the head. The posterior incision of the ulna ridge was performed in the operation, and the long oblique osteotomy was performed at the most obvious point of the ulna angle deformity. Then the Boyd incision was used to expose the humeral and radial joint and the upper ulnar radial joint. The scar tissue in the joint was cleaned and the radial head was repositioned. On the premise of maintaining the stability of the elbow joint, the ulna osteotomy was treated with plate and screw internal fixation. Results：All 32 cases were followed up for 12 to 24 months with an average of 14.8 months, of which 1 case had incision infection. There were no pain symptoms of elbow and wrist in 32 patients after operation,29 patients with elbow joint flexion and extension （130±5）°/0°, forearm pronation and supination 90°/（85±5）°;2 patients with elbow flexion and extension （ 1190/8°, 121 °/7°）, forearm pronation and supination （90°/75°, 85°/60°） ; 1 patient with elbow flexion and extension 90° /10°, forearm pronation and supination 80°/60°. According to Mackay criteria, the result was excellent in 29 cases, good in 2 cases, medium in 1 case. Conclusion： Ulna osteotomy, elbow posterior capsular release, anterior capsule contraction is a effective method in the treatment of old Monteggia＇s fracture in children.