切开探查、尺骨截骨、环状韧带复位治疗儿童陈旧性孟氏骨折的疗效分析

Open exploration,ulnar osteotomy and annular ligament reduction for chronic Monteggia fracture in children

目的探讨切开探查、尺骨截骨、环状韧带复位(三合一手术)治疗儿童陈旧性孟氏骨折的疗效。方法回顾性分析2017年6月至2021年9月天津大学天津医院小儿骨科收治的35例儿童陈旧性孟氏骨折患者资料。男22例,女13例;左侧19例,右侧16例;年龄(6.8±2.5)岁;桡骨头向前侧脱位30例,向前外侧脱位5例。受伤至手术时间为(17.9±9.9)个月。所有患者均采用三合一手术治疗。测量并比较所有患者术后12个月肘关节屈伸范围、前臂旋转范围及肘关节特种外科医院(HSS)评分。同时记录并发症发生情况。结果所有患儿术后均获12个月随访,术后1.5~4.0个月尺骨截骨端达到骨性愈合。术后12个月肘关节伸直活动度(-1.0°±5.9°)、屈曲活动度(128.5°±4.9°)均较术前(-9.3°±18.0°、108.4°±17.3°)显著改善,差异均有统计学意义(P<0.05)。术后12个月前臂旋前活动度(61.5°±19.4°)较术前(72.7°±22.4°)受限,差异有统计学意义(P<0.05);术后12个月前臂旋后活动度(86.7°±4.5°)与术前(81.0°±17.4°)比较差异无统计学意义(P>0.05)。术后12个月肘关节HSS评分[(93.5±5.2)分]优于术前[(80.6±9.3)分],差异有统计学意义(P<0.05)。术后12个月肘关节HSS评分评定疗效:优21例,良12例,一般2例,优良率94.3%(33/35)。1例患者术后发生再脱位。结论切开探查、尺骨截骨、环状韧带复位是治疗儿童陈旧性孟氏骨折安全、有效的方法。术后肘关节屈伸活动有显著改善,前臂旋前功能稍有受限。

Objective To investigate the efficacy of open exploration,ulnar osteotomy and annular ligament reduction(three-in-one surgery)in the treatment of chronic Monteggia fracture in children.Methods The data were analyzed retrospectively of the 35 children with chronic Monteggia fracture who had been admitted to Department of Pediatric Orthopaedics,Tianjin University from June 2017 to September 2021.There were 22 boys and 13 girls,and 19 left and 16 right sides,with an age of(6.8±2.5)years.Anterolateral dislocation of the radial head occurred in 30 cases and anterolateral dislocation in 5 ones.The time from injury to operation was(17.9±9.9)months.All patients were treated with three-in-one surgery.The elbow flexion and extension,forearm rotation and The Hospital for Special Surgery(HSS)elbow score were measured and compared in all patients at 12 months after operation.Their complications were also recorded.Results All children were followed up for 12 months.The osteotomy ends of the ulna achieved bony union 1.5 to 4.0 months after operation.The elbow extension(-1.0°±5.9°)and flexion(128.5°±4.9°)at 12 months after operation were significantly improved compared with those before operation(-9.3°±18.0°and 108.4°±17.3°)(P<0.05).The forearm pronation(61.5°±19.4°)at 12 months after operation was significantly limited compared with that before operation(72.7°±22.4°)(P<0.05).There was no significant difference between the forearm supination(86.7°±4.5°)at 12 months after operation and that before operation(81.0°±17.4°)(P>0.05).The HSS elbow score at 12 months after operation(93.5±5.2)was significantly higher than that(80.6±9.3)before operation(P<0.05).The efficacy evaluated by the HSS elbow score at 12 months after operation was excellent in 21 cases,good in 12 cases,and fair in 2 cases,giving an excellent and good rate of 94.3%(33/35).Postoperative re-subluxation was observed in one patient.Conclusion Open exploration,ulnar osteotomy and annular ligament reduction are a safe and effective three-in-one surgery for chronic Monteggia fracture in children,because it may lead to significantly improved elbow flexion and extension after operation,though the forearm pronation may be limited.