2种手术入路治疗儿童BadoⅠ型陈旧性孟氏骨折的疗效对比

Comparison of the efficacy of two surgical approaches in the treatment of Bado typeⅠold Monteggia fracture in children

目的探讨前后联合入路和后外侧入路2种手术方法治疗儿童BadoⅠ型陈旧性孟氏骨折的临床疗效优劣。方法回顾性分析四川省南充市中心医院2013年1月至2018年11月收治的22例BadoⅠ型陈旧性孟氏骨折患儿,11例采用前路桡骨头切开复位联合后路尺骨截骨矫形(前后路联合组),11例采用后外侧入路桡骨头切开复位、尺骨截骨矫形(后外侧入路组),术后定期随访行相关影像学检查,并进行肘关节功能评分。结果2组伤口均愈合好,无神经、血管损伤,无延迟愈合和不愈合,后外侧入路组有1例出现异位骨化,1例出现桡骨头再脱位、1例出现桡骨头半脱位;前后路联合组与后外侧入路组手术时间比较[(92.3±6.2)min vs.(122.4±5.8)min],差异有统计学意义(P<0.05);前后路联合组与后外侧入路组出血量[(52.4±7.3)mL vs.(98.3±8.6)mL]比较,差异有统计学意义(P<0.05);前后路联合组与后外侧入路组末次随访时肘关节旋前活动度比较[(81.5±8.9)°vs.(58.5±8.0)°],差异有统计学意义(P<0.05)。结论前后联合入路治疗儿童BadoⅠ型陈旧性孟氏骨折是1种较好的临床尝试。

Objective To investigate the clinical efficacy of two therapies on children with BadoⅠold Monteggia fracture.Methods From January 2013 to November 2018,a total of 22 children with Bado typeⅠchronic Monteggia fracture treated in Sichuan Nanchong Central Hospital were analyzed retrospectively.A total of 11 cases were treated by using combined anterior open reduction of radial head and posterior ulnar osteotomy(the combined anterior and posterior approach group)and 11 cases were treated by using posterolateral open reduction of radial head and ulnar osteotomy(the posterolateral approach group).Radiological outcomes and elbow joint function scores were measured after operation and during the follow-up period.Results The wound in the two groups healed well,no complications such as neurovascular and blood vessel injury and delayed union and nonunion occurred.In the posterolateral approach group,one patient had heterotopic ossification,one patient had redislocation and one patient had subluxation.There was no statistically significant difference in operation time between the combined anterior and posterior approach group and the posterolateral approach group[(92.3±6.2)min vs.(122.4±5.8)min](P<0.05).There was statistically significant difference in the bleeding in the combined anterior and posterior approach group and the posterolateral approach group[(52.4±7.3)mL vs.(98.3±8.6)mL,P<0.05].There was statistically significant difference in the range of pronation of elbow joint between the anterior and posterior approach group and the posterolateral approach group at the last follow-up[(81.5±8.9)°vs.(58.5±8.0)°],the difference was statistically significant(P<0.05).Conclusion Combined anterior and posterior approach is an effective clinical trial for BadoⅠold Monteggia fracture in children.