前后联合入路和后外侧入路治疗儿童BadoⅠ型陈旧性孟氏骨折的效果

Effect of Combined Anterior Posterior Approach and Posterolateral Approach in the Treatment of Old Monteggia Fracture of BadoⅠType in Children

目的:探讨前后联合入路和后外侧入路治疗儿童BadoⅠ型陈旧性孟氏骨折的效果。方法:将徐州市儿童医院2016年1月-2022年1月收治的44例BadoⅠ型陈旧性孟氏骨折患儿按照随机数字表法分为前后联合组和后外侧组,各22例。后外侧组予以后外侧入路桡骨头切开复位、尺骨截骨矫形,前后联合组予以前路桡骨头切开复位联合后路尺骨截骨矫形。观察两组手术相关指标、肘关节活动度、肘关节功能及并发症发生率。结果:前后联合组手术时间、切口长度、骨折愈合时间均短于后外侧组,术中出血量少于后外侧组(P<0.05)。术后6个月,前后联合组屈伸、旋前弧度高于后外侧组(P<0.05);两组旋后弧度比较,差异无统计学意义(P>0.05)。术后6个月,前后联合组Mayo肘关节功能各维度评分及总分高于后外侧组(P<0.05)。前后联合组并发症总发生率(13.64%)与后外侧组(22.73%)比较,差异无统计学意义(P>0.05)。结论:在儿童BadoⅠ型陈旧性孟氏骨折中应用前后联合入路治疗,可缩短手术时间,减小切口长度,减少术中出血量,促进骨折愈合,改善肘关节活动度,提高肘关节功能,且不增加术后并发症发生率。

Objective:To explore the effect of combined anterior posterior approach and posterolateral approach in the treatment of old Monteggia fracture of BadoⅠtype in children.Method:A total of 44 children with old Monteggia fracture of BadoⅠtype treated in Xuzhou Children’s Hospital from January 2016 to January 2022 were divided into anterior posterior combined group and posterolateral group according to random number table,with 22 cases in each group.The posterolateral group was treated with posterolateral approach open reduction of the radial head and osteotomy of the ulna for correction.The anterior posterior combined group was treated with anterior posterior approach open reduction of the radial head and posterior approach osteotomy of the ulna for correction.The operation related indexes,elbow joint mobility,elbow joint function and complication rate of the two groups were observed.Result:The operation time,incision length,fracture healing time in the anterior posterior combined group were shorter than those in the posterolateral group,and the intraoperative blood loss was less than that of the posterolateral group(P<0.05).Six months after surgery,the flexion,extension and pronation radians in the anterior posterior combined group were higher than those in the posterolateral group(P<0.05),but there was no significant difference in supination radians between the two groups(P>0.05).Six months after surgery,the scores and total scores of Mayo elbow joint function scores in the anterior posterior combined group were higher than those in the posterolateral group(P<0.05).There was no significant difference in the total incidence of complications between the anterior posterior combined group(13.64%)and the posterolateral group(22.73%)(P>0.05).Conclusion:The application of combined anterior posterior approach in the treatment of old Monteggia fracture of BadoⅠtype in children can shorten the operation time,reduce the length of incision,reduce the amount of intraoperative bleeding,promote fracture healing,improve the range of motion of elbow joint,improve the function of elbow joint,and do not increase the incidence of postoperative complications.