孟氏骨折手法整复儿童桡骨头再脱位影响因素分析

Analysis of Factors Influencing the Re-dislocation of the Radial head of Children with Monteggia Fracture

目的:探讨孟氏骨折手法整复儿童桡骨头再脱位影响因素。方法:回顾性分析2015年8月—2019年10月该院收治的82例孟氏骨折手法整复桡骨头再脱位患儿临床资料。所有患儿均予以手法整复,随访8~12个月,根据复查结果明确患者是否发生桡骨头再脱位,统计82例孟氏骨折手法整复桡骨头再脱位患儿的基线资料,包括性别、骨折损伤机制、石膏制动是否准确等,统计患者桡骨头再脱位发生率,分析孟氏骨折手法整复儿童桡骨头再脱位的影响因素。结果:经手法整复治疗的患儿中,23例发生桡骨头再脱位,发生率为28.05%。将全部可能的影响因素纳入,经单因素与多因素分析结果显示,骨折损伤机制(滑脱和/或撕裂的环状韧带坎墩于上尺桡关节之间)、石膏制动不准确、石膏松动或固定不牢、功能锻炼不合理、桡骨头生长过度均是孟氏骨折手法整复发生桡骨头再脱位的危险因素(OR>1,P<0.05)。结论:骨折损伤机制(滑脱和/或撕裂的环状韧带坎墩于上尺桡关节之间)、石膏制动不准确、石膏松动或固定不牢、功能锻炼不合理、桡骨头生长过度均可导致孟氏骨折手法整复后发生桡骨头再脱位,临床可据此进行合理的干预,以降低患儿桡骨头再脱位风险,改善预后。

Objective:To investigate the influencing factors of radial head redislocation in children with Monteggia fracture manipulation.Methods:A retrospective analysis of the clinical data of 82 children with Monteggia fractures treated in our hospital from August 2015 to October 2019 was performed.All the children were treated with manual restoration and were followed up for 8 to 12 months.According to the reexamination results,it was determined whether the patients had redislocation of the radial head.The baseline data of 82 children with Monteggia fractures with manual restoration of the radial head were counted,including gender,The mechanism of fracture injury,whether the plaster immobilization is accurate,etc.,the incidence of radial head redislocation in patients was counted,and the influencing factors of radial head redislocation in children treated with Monteggia fractures were analyzed.Results:Among the children treated with manual reconstruction,23 cases of radial head redislocation occurred,and the incidence rate was 28.05%.Including all possible influencing factors,the results of univariate and multivariate analysis showed that the fracture injury mechanism(slipped and/or torn annular ligament ridge between the upper radioulnar joint),inaccurate cast immobilization,Plaster loosening or immobilization,unreasonable functional exercise,and excessive radial head growth were all risk factors for radial head redislocation(OR>1,P<0.05).Conclusion:The mechanism of fracture injury(slipped and/or torn annular ligament bridging between the upper radioulnar joint),inaccurate immobilization of casts,loose or unstable casts,unreasonable functional exercise,and excessive radial head growth All of them can lead to the redislocation of the radial head after the manipulative reduction of Monteggia fractures.Therefore,reasonable clinical intervention can be carried out to reduce the risk of redislocation of the radial head and improve the prognosis in children.