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TREATMENT OF OLD RADIAL HEAD DISLOCATION IN CHILDREN

ObjectiveTo evaluate the short-term effectiveness of transarticular fixation of humeroradial joint by Kirschner wire (or combined with proximal ulnar osteotomy) for old radial head dislocation after open reduction of the radial head in children. MethodsA retrospective analysis was made on the clinical data of 25 children with old radial head dislocation between January 2008 and December 2010.There were 18 boys and 7 girls,aged 2 years and 5 months to 9 years and 5 months (mean,5 years and 11 months).The left side was involved in 13 cases,and the right side in 12 cases.The interval of injury and operation was 3 weeks to 30 months (median,14 months).The main presentations were abnormal mass in the anterior elbow,motion limitation of forearm pronation,and dorsiflexion inability of wrist and thumb.Three patients had radial nerve lesion.In 23 patients with simple radial head dislocation,transarticular fixation of humeroradial joint by Kirschner wire was used after open reduction of the radial head; in 2 patients with Monteggia fracture,transarticular fixation by Kirschner wire and additional proximal ulnar osteostomy were used. ResultsA primary healing of incision was obtained,without complication of infection,joint stiffness,or radial head necrosis.Twenty-four patients were followed up 29-58 months (mean,44.3 months); one case had re-dislocation,failed to be followed up at 2.5 months postoperatively.In 3 patients with radial nerve injury,neural function recovery was obtained in 2 cases,and no improvement was observed in 1 case.Twenty-three had no pain,no deformity,and no motion limitation of elbow and forearm except 1 patient with no improvement of neural function.The mean range of montion (ROM) of elbow flexion was 134° (range,125-140°),and the mean ROM of extension was -4° (range,-8-0°); the mean ROM of forearm pronation was 74° (range,65-80°),and the ROM of supination was 90°.According to Mackay's criteria,the results were excellent in 22 cases,good in 1 case,and poor in 1 case at 2 years after operation. ConclusionThe transarticular fixation of humeroradial joint by Kirschner wire (or combined with proximal ulnar osteotomy) is a feasible and effective method to treat old radial head dislocation in children based on a short-term follow-up.

成人孟氏骨折的手术治疗

【摘要】目的总结成人盂氏骨折的手术治疗方法及疗效。方法2003年3月2009年3月,收治21例成人孟氏骨折。男16例,女5例;年龄18～52岁,平均年龄25岁。致伤原因:车祸伤12例, 摔伤6例,砸伤3例。根据Bado分型标准:Ⅰ型6例,Ⅱ型11例,Ⅲ型3例,Ⅳ型1例。受伤至手术时间1 h～10 d,平均25 d。均采用手术治疗,行骨折脱位解剖复位内固定、环状韧带修复重建、损伤神经探查修复处理。结果手术后21例均获随访,随访时间6～48个月,平均随访时间264个月。骨折均于手术后6个月骨性愈合,无畸形及桡骨小头再脱位发生。肘关节及前臂功能按照Anderson评分标准:优14例,良4例,可2例,差1例,优良率857%。结论成人孟氏骨折应尽早手术治疗,骨折脱位的解剖复位、可靠固定及环状韧带的修复重建是手术成功的关键,同时注重受累神经的处理及早期功能锻炼,以最大程度地恢复肘关节及前臂的功能。

Application of annular ligament reposition and repair via Henry’s approach for Monteggia fracture in children

ObjectiveTo explore the effectiveness of annular ligament reposition and repair via Henry’s approach for Monteggia fracture in children.MethodsA clinical data of 21 children with Monteggia fractures was retrospectively analysed, who underwent open reduction of the radial head and annular ligament reposition and repair via Henry’s approach between May 2015 and July 2019. There were 11 boys and 10 girls with an average age of 8 years and 1 month (range, 4 years and 5 months to 14 years and 4 months). The fracture was caused by falling in 17 cases and by falling from height in 4 cases. There were 16 fresh fractures and 5 old fractures. The Monteggia fractures were rated as Bado typeⅠin 14 cases and Bado type Ⅲ in 7 cases. Preoperative MRI examination and intraoperative observation confirmed that the annular ligament was intact. After operation, the fracture healing, elbow range of motion (ROM), and complications were recorded, and the effectiveness was evaluated according to the Mackay’s function scoring system.ResultsThe incisions healed by first intention after operation, and there was no complication such as radial nerve injury. All children were followed up 12-25 months, with an average of 15 months. No dislocation or subluxation of the radial head occurred after operation. At last follow-up, the ROM of elbow flexion and extension of the children with old fractures increased from (92.6±11.2)° before operation to (123.6±11.6)°, and the ROM of forearm rotation from (96.8±11.8)° to (129.8±5.9)°; the differences between pre- and post-operation were significant (t=7.672, P=0.002; t=9.487, P=0.001); the ROM of elbow flexion and extension of the children with fresh fractures was 139°-156° (mean, 145°); the ROM of forearm rotation was 158°-168° (mean, 162°). According to Mackay’s criteria, 17 cases were excellent and 4 cases were good, with an excellent and good rate of 100%. X-ray film examination showed no nonunion, heterotopic ossification, or loosening of internal fixation after operation. The ulnar fracture and the ulnar osteotomy healed in all cases.ConclusionThe annular ligament in Monteggia fractures in children is intact. Compared with the reconstruction of the annular ligament, the reposition and repair of the annular ligament via Henry’s approach is closer to the original anatomical state of the annular ligament and has the advantages of less trauma and fewer complications.

伴严重畸形的小儿陈旧性孟氏骨折修复重建

目的 介绍一种治疗伴严重畸形小儿陈旧性孟氏骨折的手术方法。 方法 2000 年6 月－ 2006 年3 月，收治13 例伴严重畸形的陈旧性孟氏骨折患儿。男11 例，女2 例；年龄4 ～ 11 岁。左侧5 例，右侧8 例。病程6 个月～ 3 年，平均17 个月。按Bado 分型，Ⅰ型6 例，Ⅱ型3 例，Ⅲ型3 例，Ⅳ型1 例。采用尺骨近端截骨延长矫形、桡骨远端缩短截骨双接骨板内固定，术后早期功能锻炼的方法进行治疗。 结果 13 例患者均获随访，随访时间9 个月～ 4 年，平均2 年3 个月。按照朱玉奎等疗效评定标准，优7 例，良5 例，可1 例，优良率92.3%。 结论 尺骨延长、桡骨缩短双截骨方法矫形彻底，创伤小，术后功能恢复良好，是治疗伴严重畸形的小儿陈旧性孟氏骨折的一种较好方法。

儿童肱骨外髁骨折合并孟氏骨折二例

EFFECTIVENESS OF MODIFIED OPERATION FOR TREATMENT OF OLD MONTEGGIA FRACTURE

ObjectiveTo investigate the effectiveness of a modified surgical treatment of old Monteggia fracture. MethodsBetween March 2006 and December 2013, 40 cases of old Monteggia fracture were treated with modified operation. Modified operation procedure included expanding excision of pedicled forearm fascia flap for reconstruction of the annular ligament and repair of elbow radial lateral collateral ligament complex and extending osteotomy of the ulna, callus replantation, and internal fixation with steel plate. There were 26 boys and 14 girls, aged 2-10 years with an average age of 4 years. Injury was caused by falling in 24 cases, by traffic accident in 8 cases, and by falling from height in 8 cases. The disease duration was 2-11 months (mean, 4 months). Four patients had combined radial nerve palsy. ResultsIncision healed by first intention after operation, without early complication of radial nerve palsy, fascial compartment syndrome, or decreased hand extensor muscle strength. All the children were followed up 1-5 years (mean, 2.5 years). X-ray films showed fracture healing, and the healing time was 10-20 weeks (mean, 15 weeks). During follow-up, 3 cases had re-dislocation. Neither hand dysfunction caused by hand muscle adhesion nor radial head bottleneck shape change was found. On the basis of the functional evaluation criteria by Mackay, the results were excellent in 32 cases, good in 5 cases, and poor in 3 cases; the excellent and good rate was 92.5% at last follow-up. ConclusionThe modified surgical treatment of old Monteggia fracture is an effective method, with good matching of humeroradial joint and without internal fixation of the humeroradial joint.

肘关节后方入路结合钢板螺钉内固定治疗向后孟氏骨折脱位

目的总结肘关节后方单切口入路结合钢板螺钉内固定治疗向后孟氏骨折脱位的疗效。 方法2012年1月－2014年1月，收治9例向后孟氏骨折脱位患者，均经肘关节后方单切口入路行钢板螺钉内固定。男6例，女3例；年龄25～49岁，平均33.7岁。致伤原因：高处坠落伤5例，摔伤4例。骨折分型：Jupiter A型3例，B型4例，C型2例。均合并不同程度桡骨小头骨折。伤后至手术时间为5～9 d，平均6.5 d。 结果术后患者切口均Ⅰ期愈合。9例患者均获随访，随访时间13～32个月，平均16.3个月。X线片复查示骨折均愈合，愈合时间2～4个月，平均3.2个月；随访期间无创伤性骨关节炎及异位骨化等发生。末次随访时，Mayo肘关节功能评分87～95分，平均91.7分；其中优6例，良3例，优良率100%。 结论采用肘关节单切口入路结合钢板螺钉内固定治疗向后孟氏骨折脱位具有手术视野显露充分、损伤小等优点，可获得较好疗效。

特殊型孟氏骨折38例的治疗分析

【摘要】　目的　探讨特殊型孟氏骨折的临床特征和治疗效果。　方法　1998年3月-2008年12月收治38例孟氏骨折中，34例为新鲜骨折，4例为陈旧骨折；其中7例新鲜骨折合并桡神经损伤，桡神经均未探查。新鲜骨折均先行手法复位石膏外固定，仅5例复位效果满意，其余均行手术治疗。术中15例行环状韧带修补，8例行环状韧带重建。　结果　38例均获随访，时间为6～48个月；非手术患者平均8个月，手术患者平均22个月。疗效：优25例，良9例，中3例，差1例，优良率89.5%，桡神经损伤完全恢复。　结论　特殊型孟氏骨折对骨折愈合、复位及功能恢复要求很高，若手法复位效果不佳，则应及早采取手术治疗为好。

CLASSIFICATION AND TREATMENT OF MONTEGGIA EQUIVALENT FRACTURES IN CHILDREN

Objective To investigate the classification and treatment of Monteggia equivalent fractures in children. Methods A retrospective analysis was made on the clinical data of 35 cases of Monteggia equivalent fractures between January 2008 and January 2012. There were 17 boys and 18 girls with an average age of 7 years and 5 months (range, 1 year and 2 months to 14 years and 11 months). The causes of injury were tumbling injury in 25 cases, falling injury in 3 cases, and sport injury in 7 cases. The disease duration from injuries to admission ranged from 1 hour to 16 days (median, 28 hours). According to the criteria of self-made classification, there were 22 cases of type I (ulnar fracture with radial neck fracture or proximal radial epiphysis injury), 2 cases of type II (posterior elbow dislocation with radial neck fracture or proximal radial epiphysis injury), 10 cases of type III (ulnar fracture and/or olecranon fracture with humeral lateral condylar fracture), and 1 case of type IV (fractures of radius and ulna with radial neck fracture or proximal radial epiphysis injury). All patients were treated by open reduction and internal fixation/external fixation. Results All incisions healed by first intention without infection. Thirty-four cases were followed up 14 months on average (range, 12-18 months). All fractures healed at 2.5 months on average (range, 6 weeks to 5 months). According to Hospital for Special Surgery (HSS) score system, the results were excellent in 29 cases, good in 4 cases, and fair in 2 cases, with an excellent and good rate of 94%. No cubit varus/valgus or delayed ulnar nerve injury was observed. Conclusion New self-made classification is simple and easy to remember, and it is helpful to reduce omission diagnose rate and select therapeutic methods. Surgery is an effective method to treat Monteggia equivalent fractures.

改良 Boyd 切口治疗Bado Ⅱ型孟氏骨折

目的总结 Bado Ⅱ型孟氏骨折手术中采用改良 Boyd 切口的优势及疗效。方法2010 年 1 月—2014 年 9 月采用改良 Boyd 切口手术复位治疗 15 例 Bado Ⅱ型孟氏骨折患者。男 8 例，女 7 例；年龄 27～49 岁，平均 35 岁。均合并尺骨鹰嘴骨折、桡骨头骨折、冠状突骨折。受伤至手术时间 10～14 d，平均 12 d。术后复查肘关节正侧位 X 线片，观察骨折愈合情况；评估前臂屈伸及旋前、旋后活动度；采用改良 Broberg 和 Money 标准评估肘关节功能。结果术后切口均Ⅰ期愈合，未发生感染或切口不愈合。15 例均获随访，随访时间 14 个月～2 年 11 个月，平均 2 年 6 个月。术后 12～14 个月骨折均获得骨性愈合，平均 12.7 个月。术后 12 个月，肘关节屈伸活动度为（116.65±19.88）°，旋转活动度为（115.33±18.46）°，均未发生桡骨头复发性脱位等并发症；1 例发生轻度异位骨化，但不影响患肢活动。末次随访时按照 Broberg 和 Money 标准评价肘关节功能，优 5 例，良 7 例，可 3 例。结论改良 Boyd 切口能够对 Bado Ⅱ型孟氏骨折有良好的显露，具有直观、操作方便等优点。