克氏针固定上尺桡关节治疗成人孟氏骨折的临床研究

Clinical study on proximal radioulnar joint fixation with Kirschner wire for treating adult Monteggia fracture

目的探讨克氏针固定上尺桡关节治疗成人孟氏骨折的临床效果。方法选择62例成人孟氏骨折患者为研究对象,采用随机数字表法随机分成研究组和对照组,每组31例。对照组接受常规手术治疗,研究组予克氏针固定上尺桡关节。观察两组临床疗效、手术时间、术中出血量、骨折愈合时间、并发症等情况。结果研究组手术时间明显长于对照组,骨折愈合时间明显短于对照组,差异有统计学意义(P <0. 05);两组术中出血量比较,差异无统计学意义(P> 0. 05)。与术前相比,两组术后疼痛、功能、伸屈范围、肌力、屈伸、旋转及总分均获得显著提高,且研究组提高幅度大于对照组,差异均有统计学意义(P <0. 05)。研究组临床预后、影像学预后均优于对照组,差异有统计学意义(P <0. 05)。研究组桡骨头复位不良或再脱位、骨折成角畸形、骨折延迟愈合或不愈合、功能障碍发生率均明显低于对照组,差异有统计学意义(P <0. 05)。结论克氏针固定上尺桡关节治疗成人孟氏骨折临床效果显著,但临床上仍要结合骨折情况采用个体化方案治疗。

Objective To investigate the clinical efficacy of proximal radioulnar joint fixation with Kirschner wire for treating adult Monteggia fracture. Methods Sixty-two cases of adult with Monteggia fracture were selected as the objects,and were divided into study group（n = 31） and control group（n = 31）using random number table. The control group received conventional surgical treatment,and the study group received proximal radioulnar joint fixation using Kirschner wire. The clinical efficacy,operative duration,intraoperative blood loss,duration for fracture healing and complications,and so on,were observed in both groups. Results The operative duration was longer,but the duration for fracture healing was shorter in the study group compared to the control group（P〈0. 05）. There was no significant difference in the intraoperative blood loss between the two group（P〉0. 05）. The scores of pain,function,range of flexion and extension,muscle force,flexion/extension and rotation,and the total score in both groups were significantly higher after operation compared to the scores before operation（P〈0. 05）,and the increase amplitude of the study group was higher than that of the control group（P〈0. 05）. The clinical prognosis and imaging prognosis of the study group were superior to those of the control group（P〈0. 05）. The incident rates of poor caput radii malreduction or redislocation,angulation deformity of fracture,delayed union or nonunion of fracture,and dysfunction were significantly lower in the study group compared to the control group（P〈0. 05）. Conclusion Proximal radioulnar joint fixation with Kirschnercan wire obtains a remarkable clinical efficacy for adult Monteggia fracture. But individual plan should be adopted clinically on the basis of fracture condition.