成人后孟氏骨折与经尺骨近端骨折后脱位的鉴别与治疗

Differential diagnosis and treatment of posterior Monteggia fracture and posterior dislocation of proximal ulna fracture

经典孟氏骨折的定义是尺骨骨折伴上尺桡关节脱位,如合并桡骨头后脱位,即肱桡关节后脱位时,称为后孟氏骨折。而对于不伴有上尺桡关节脱位者,不应笼统称为后孟氏骨折,可称为经尺骨近端骨折后脱位。对于伴有上尺桡关节脱位后孟氏骨折,临床相对少见,其冠突骨折通常粉碎,上尺桡关节遭到破坏,环状韧带及骨间膜损伤,治疗时在恢复骨性结构及处理外侧韧带复合体后,还须关注与处理上尺桡关节的稳定,预后疗效不确定。而经尺骨近端骨折后脱位临床相对多见,其冠突骨折块通常完整,环状韧带及骨间膜完好,在治疗上以恢复骨性结构为主,同时处理肘关节外侧韧带复合体,预后效果好。通过解剖基础、影像学特征、损伤特点、治疗方法及预后等方面鉴别和区分后孟氏骨折与经尺骨近端骨折后脱位。

A classical Monteggia fracture is defined as an ulnar fracture with dislocation of the proximal radioulnar joints.If combined with posterior dislocation of the radial head(posterior dislocation of the radiocapitellar joints),it is called a posterior Monteggia fracture.And for those without dislocation of the proximal radioulnar joints,it should not be defined as the posterior Monteggia fracture,but as the posterior dislocation of the proximal ulna fracture.For dislocation of the proximal radioulnar joints,the Monteggia fractures,clinical are relatively rare.The coronoid process fracture is comminuted,the proximal radioulnar joints are destroyed,the membrane and the annular ligament is injured.After restoring osseous structure and repairing the lateral ligament complex,we must also pay attention to the stability of proximal radioulnar joints,and the prognostic efficacy not sure.However,posterior dislocation of proximal ulna fractures is relatively common in clinical practice,and the coronal process fracture is usually complete,with the annular ligament and interosseous membrane intact.In treatment,the bone structure is mainly restored,and the lateral ligament complex of elbow joint is treated at the same time,with good prognosis.Through anatomical basis,imaging characteristics,injury characteristics,treatment and prognosis,we can distinguish with the posterior Monteggia fracture and posterior dislocation of proximal ulna fracture.