关节造影在儿童新鲜孟氏骨折的应用

Arthrography used in the treatment of fresh Monteggia fractures in children

[目的]探讨关节造影在儿童新鲜孟氏骨折诊疗中的应用价值。[方法]本研究共纳入46例新鲜孟氏骨折患儿。所有患儿均行肘关节造影术,依据骨折类型与造影结果分别给予不同治疗。评价临床与影像资料。[结果]46例中,3例行手法整复石膏固定,15例行弹性髓内钉固定,8例行钢板螺钉固定,7例行克氏针张力带固定,8例行Mini-ilizarov外固定架固定,5例行单边外固定架固定。所有患者均顺利完成治疗,均无严重并发症,造影时间(5.83±2.75)min;治疗操作时间(46.58±10.45)min。本组病例均获随访(13.06±3.27)个月,恢复完全负重活动时间(12.16±1.31)周。末次随访肘关节屈伸活动范围平均(145.65±6.16)°,前臂旋转活动范围平均(163.20±3.62)°。骨折临床愈合时间平均(11.53±1.06)周。依据Mayo评分,临床结果优43例,良3例,优良率100%。影像方面,术后所有患儿桡骨颈轴延长线均通过肱骨小头骨骺,肱桡关节对位良好。术后4周复查X线片示断端均有骨痂形成。[结论]对于儿童新鲜孟氏骨折行肘关节造影能清楚地显示出肘关节形态,准确反映复位效果。

[Objective]To investigate the value of arthrography used in the diagnosis and treatment of Monteggia fracture in children.[Methods]A total of 46 children with Monteggia fracture were included in this study.All patients underwent elbow arthrography,followed by different treatments based on fracture type and arthrographic results.The clinical and imaging data were evaluated.[Results]Among the46 patients,3 underwent manipulation reduction and external fixation with plaster cast,15 underwent elastic intramedullary nailing,8 underwent plate and screw fixation,7 underwent Kirschner wire tension band fixation,8 underwent mini-Ilizarov external fixator,and 5 underwent unilateral external fixator.All patients had the corresponding treatments performed successfully without serious complications,with the arthrography time of(5.83±2.75)min,therapeutic operation time of(46.58±10.45)min.The patients were followed up for(13.06±3.27)months,and resumed full weight-bearing activity in(12.16±1.31)weeks.The clinical fracture healing time was of(11.53±1.06)weeks,with the elbow flexion-extension range of motion(ROM)of(145.65±6.16)°and the forearm rotation ROM of(163.20±3.62)°at the latest follow up.According to Mayo score,the clinical results were marked as excellent in 43 cases and good in 3 cases,with an excellent/good rate of 100%.Radiographically,the radial axis passed through the center of capitellum with well humeroradial alignment was proved after the treatments,and callus formation on the fracture ends was observed in all patients on images 4 weeks after treatments.[Conclusion]Elbow arthrography does clearly show the congruence of the joint,which accurately reflect the reduction consequence in children with Monteggia fractures.