目的 探讨环形韧带修复对儿童陈旧性孟氏骨折尺骨截骨术预后的影响。 方法 回顾2013年3月至2022年1月收治的30例陈旧性孟氏骨折患儿的病例资料，采用单纯尺骨截骨矫形17例（A组），联合环状韧带修复13例（B组）。末次手术后随访13～96个月，平均随访18个月。按照Kim评分标准、肘关节活动度及影像学结果分析其预后。 结果 按照Kim功能评分标准，术后两组优良率比较差异无统计学意义（P>0.05）。肘关节总活动度两组比较，差异无统计学意义（P>0.05）；X光片结果显示30例截骨端均愈合良好,28例肱桡关节复位良好，2例术后桡骨头向外侧轻度半脱位。 结论 尺骨延长-成角是治疗儿童陈旧性孟氏骨折的关键，此基础上环形韧带修复不是预后的决定性因素。
Abstract
Objective To evaluate the effect of repairing of annular ligament in the treatment of pediatric chronic Monteggia fracture based on ulnar osteotomy. Methods Between March 2013 to January 2022, a retrospective case series study was conducted to analyze 30 children with chronic Monteggia fracture-dislocations. In all cases were treated with open reduction of the radial head and lengthening-angulation osteotomy of ulnar, in of which 17 cases underwent only lengthening-angulation osteotomy of ulna (Group A), 13 combined annular ligament repairing (Group B). Following up was performed for mean 18 (range, 12 to 96) months postoperatively. The outcome was evaluated by the Kim score and range of motion, and radiography. Results There was no statistical difference in the excellent-and-good rate between group A and group B (P>0.05), according to Kim score. There was no statistical difference in the total elbow range of motion between group A and group B (P>0.05). There were no complications of nonunion in follow-up radiographs. Relocation of radiocapitellar joint were observed in 28 cases, radial head subluxation recurred in 2 cases. Conclusions Lengthening-angulation osteotomy of ulna is the key in the treatment of chronic Monteggia fractures, on the basis of which the repairing of annular ligament is not a major determinant for prognosis.
关键词
陈旧性孟氏骨折 /
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桡骨头脱位 /
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尺骨截骨 /
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环状韧带 /
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儿童
Key words
Chronic Monteggia fracture /
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Dislocated radius head /
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Ulnar osteotomy /
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Annular ligament /
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Pediatric
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参考文献
[1] Song KS, Ramnani K, Bae KC, et al. Indirect reduction of the radial head in children with chronic Monteggia lesions[J]. J Orthop Trauma, 2012, 26(10):597-601. DOI: 10.1097/BOT. 0b013e3182548981.
[2] Anderson A, Werner FW, Tucci ER, et al. Role of the interosseous membrane and annular ligament in stabilizing the proximal radial head[J]. J Shoulder Elbow Surg, 2015,24(12):1926-1933. DOI: 10.1016/j.jse.2015.05.030.
[3] Ramski DE, Hennrikus WP, Bae DS, et al. Pediatric monteggia fractures: a multicenter examination of treatment strategy and early clinical and radiographic results[J]. J Pediatr Orthop, 2015,35(2):115-120. DOI: 10.1097/BPO.0000000000000213.
[4] 李存, 丁晓飞. 儿童陈旧孟氏骨折的治疗进展[J]. 中华小儿外科杂志, 2017，38(7):556-560. DOI：10.3760/cma.j.issn.0253-3006. 2017. 07.016.
[5] 李龙, 姚阳阳, 王佳琦, 等. Boyd入路环状韧带复位联合尺骨截骨术治疗儿童陈旧性孟氏骨折的疗效观察[J]. 中华解剖与临床杂志, 2021,26(5):585-588. DOI：10.3760/cma.j.cn101202-20201014-00355.
[6] Kim HT, Park BG, Suh JT, et al. Chronic radial head dislocation in children, Part 2: results of open treatment and factors affecting final outcome[J]. J Pediatr Orthop, 2002,22(5):591-597. DOI：10.1097/01241398-200209000-00005.
[7] Tan S, Low JY, Chen H, et al. Surgical management of missed Pediatric monteggia fractures: a systematic review and meta-analysis[J]. J Orthop Trauma,2022, 36(2):65-73. DOI: 10.1097/BOT. 00000000 00002219.
[8] Stragier B, De Smet L, Degreef I. Long-term follow-up of corrective ulnar osteotomy for missed Monteggia fractures in children[J]. J Shoulder Elbow Surg, 2018, 27(11):e337-e343. DOI: 10.1016/j.jse.2018.06.029.
[9] Chen HY, Wu KW, Dong ZR, et al. The treatment of chronic radial head dislocation in Monteggia fracture without annular ligament reconstruction[J]. Int Orthop, 2018, 42(9):2165-2172. DOI: 10.1007/s00264-018-3943-6.
[10]Biewener A, Bischoff F, Rischke T, et al. Instability of the proximal radioulnar joint in Monteggia fractures-an experimental study[J]. J Orthop Surg Res, 2019,14(1):392. DOI: 10.1186/s13018-019-1367-7.
[11]Hayami N, Omokawa S, Iida A, et al. Effect of soft tissue injury and ulnar angulation on radial head instability in a Bado type I Monteggia fracture model[J]. Medicine (Baltimore), 2019,98(44):e17728. DOI: 10.1097/MD.0000000000017728.
[12]Hetthessy JR, Sebok B, Vadasz A, et al. The Three Step Approach to the management of acute pediatric Monteggia lesions[J]. Injury, 2021, 52 Suppl 1:S57-S62. DOI:10.1016/j.injury. 2020.02.033.
[13]Canton G, Hoxhaj B, Fattori R, et al. Annular ligament reconstruction in chronic Monteggia fracture-dislocations in the adult population: indications and surgical technique[J]. Musculoskelet Surg, 2018,102(Suppl 1):93-102. DOI: 10.1007/s12306-018-0564-6.
[14]Langenberg LC, Beumer A, The B, et al. Surgical treatment of chronic anterior radial head dislocations in missed Monteggia lesions in children: A rationale for treatment and pearls and pitfalls of surgery[J]. Shoulder Elbow, 2020,12(6):422-431. DOI: 10.1177/17585732198 39225.
基金
云南省卫健委临床中心建设重大项目 （ZX2019 1001）
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