经肘关节后侧扩大入路内固定治疗向后孟氏损伤合并桡骨近端粉碎骨折的临床疗效

Efficacy of extensile posterior approach through elbow joint in the internal fixation osteosynthesis treatment for posterior Monteggia fractures with the proximal radius metaphysis comminuted fracture

目的探讨经肘关节后侧扩大入路内固定治疗成人向后孟氏损伤合并桡骨近端粉碎骨折的临床疗效。方法回顾性分析2013年6月至2017年7月河北省唐山市第二医院创伤骨科收治的合并桡骨近端粉碎骨折成人向后孟氏损伤患者23例,男14例,女9例;平均年龄49.5(35~66)岁。患者均采用尺骨鹰嘴解剖锁定钢板固定尺骨近端骨折及微型锁定钢板固定桡骨近端骨折。结果23例患者术后均获得随访,平均随访时间为15.5(13~22)个月;合并桡骨近端粉碎骨折成人向后孟氏损伤患者均获得骨性愈合,骨折平均愈合时间为3.2(2.5~4.0)个月。术后12个月随访无骨折不愈合、内固定断裂失效、肘关节半脱位、感染、医源性神经损伤等并发症。并采用Mayo肘关节功能评分系统(MEPS)评分进行随访的疗效评定,结果为优13例,良8例,可2例,差0例,平均92(0~100)分,优良率为91.3%。结论应用经肘关节后侧扩大入路内固定治疗成人向后孟氏损伤合并桡骨近端粉碎骨折的临床治疗效果确切,患者尺骨鹰嘴及桡骨头颈骨折愈合率高,无骨折不愈合及内固定断裂发生,肘关节功能良好。

Objective To inquire the efficacy of extensile posterior approach through elbow joint in the internal fixation osteosynthesis treatment with posterior Monteggia fractures with the proximal radius metaphysis comminuted fracture.Methods A retrospective analysis including 23 patients with the proximal radius metaphysis comminuted fracture associated with the posterior Monteggia fractures in adult were treated by extensile posterior approach through elbow in the internal fixation osteosynthesis in Department of Orthopaedics,the Second Hospital of Tangshan from June 2013 to July 2017.The data of patients:14 males and 9 females aged 35 to 66(mean,49.5)years.All patients were treated in the proximal ulnar and radius osteosynthesis with pre-contoured locking compression plate and mini-plate for the posterior Monteggia fractures.Results All of the 23 patients were followed up from on average of 15.5(13-22)months.All patients obtained good fracture union.The mean time of the fracture union was 3.2(range 2.5-4.0)months.No nonunion,metal failure,elbow dislocation,osteomyelitis and iatrogenic nerve injury occurred until 12 months follow-up.At 12 months follow-up of postoperation,patient scores for MEPS were 92(range 70-100)scores:13 cases excellence,8 cases good,2 cases fair,0 case poor.Conclusion The extensile posterior approach through elbow joint in the internal fixation osteosynthesis treatment for posterior Monteggia fractures with the proximal radius metaphysis comminuted fracture could obtain highly proximal ulnar and radius fracture union and good elbow function without nonunion and metal failure.