儿童陈旧性孟氏骨折的手术时机

Surgical timing for old Monteggia fracture in children

[目的]分析儿童陈旧性孟氏骨折手术治疗时机对疗效及预后的影响。[方法]选取2012年3月~2019年6月在本院实施手术治疗的陈旧性孟氏骨折患儿63例,根据损伤至手术时间分两组,≤6个月组30例,>6个月组33例。对比两组的围手术期、随访与影像资料。[结果]两组患儿均顺利手术,术中无血管、神经损伤等严重并发症。≤6个月组手术时间、术中失血量、术中透视次数、术后引流量和住院天数均显著优于>6个月(P<0.05)。≤6个月组完全负重活动时间显著早于>6个月组(P<0.05)。与术前相比,末次随访时两组患者肘屈伸ROM均显著增加(P<0.05),两组旋前ROM均显著减少(P<0.05),而两组旋后ROM无显著改变(P>0.05)。末次随访时,≤6个月组的屈伸ROM显著大于>6个月组(P<0.05)。与术前相比,末次随访时两组患者Kim评分均显著增加(P<0.05)。术前两组间Kim评分的差异无统计学意义(P>0.05);末次随访时,≤6个月组的Kim评分显著高于>6个月组(P<0.05)。[结论]对儿童陈旧性孟氏骨折应尽早实施手术治疗,不但可节省手术时间,减少失血量,还有利于肘关节功能的恢复。

[Objective] To analyze the effect of the timing of the surgical treatment of old Monteggia fractures in children on the efficacy and prognocis. [Methods] From March 2012 to June 2019, a total of 63 children underwent surgical treatment for old Monteggia fractures in our hospital were selected. Based on the time elapsed between injury and surgical treatment, 30 patients had operation performed equal to or within 6 months(≤6-month group), while the remaining 33 patients received surgical treatment more than 6 months(>6-month group). The perioperative, follow-up and radiographic data were compared between the two groups. [Results] All patients in both groups had surgical procedures performed smoothly without serious complications, such as nerve or blood vessel injuries. The ≤6-month group proved significantly superior to the >6-month group regarding to operation time, intraoperative blood loss, intraoperative fluoroscopic frequency, postoperative drainage and hospital stay(P<0.05). Compared with those before operation, the range of motion(ROM) in flexion-extension significantly increased in both groups at the latest follow up(P<0.05), whereas the ROM of pronation significantly decreased(P<0.05), and ROM of supination remained unchanged at the latest follow up in both group(P>0.05). The ≤6-month group had significantly greater ROM in flexion-extension than the >6-month group at the latest follow up(P<0.05). In addition, the Kim scores significantly increased in both groups compared with those before operation(P<0.05). The ≤6-month group had significantly greater Kim score than the >6-month group at the latest follow up(P<0.05), but without a statistically significant difference between them before operation(P>0.05). [Conclusion] The old Monteggia fracture in children should be surgically treated as early as possible, not only to save operation time, reduce blood loss, but also to achieve better functional recovery.