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目的探讨儿童陈旧性孟氏骨折遗留关节功能障碍早期手术方法及近期疗效。方法回顾性分析2009-01—2014-06诊治的16例儿童陈旧性孟氏骨折。7例行尺骨截骨矫形,9例行尺骨截骨延长;然后均行桡骨头切开复位、环状韧带修补及关节囊紧缩缝合术。10例肱桡关节克氏针贯穿固定,7例尺骨截骨端克氏针髓内固定,9例接骨板固定。结果16例均获得随访12~28个月,平均15.6个月。末次随访时,1例前臂旋前受限于50°。肘关节伸直0°~10°,平均4°;屈曲120°~145°,平均133°;旋前70°~90°,平均75°;旋后80°~90°,平均87°。疗效采用Mackay临床功能标准评定,优8例,良7例,差1例。结论儿童陈旧性孟氏骨折早期手术,尺骨截骨矫形(或延长)、桡骨头切开复位是恢复肱桡关节及上尺桡关节正常结构的关键,视桡骨头稳定情况行肱桡关节克氏针短期固定,为关节功能早期恢复创造条件。
Objective To investigate the early surgical methods and short-term curative effects of left-over Monteggia fracture left by children with dysfunction of joints. Methods A retrospective analysis of 16 cases of children with old Monteggia fractures diagnosed and treated from January 2009 to June 2014 was conducted. 7 cases of ulnar osteotomy and orthopedic, 9 cases of ulnar osteotomy extension; and then underwent radial head open reduction, annular ligament repair and joint capsule contraction suture. 10 cases of Kirschner wire fixation of brachial and radial joint, 7 cases of ulnar end of Kirschner wire fixation, 9 cases of plate fixation. Results 16 cases were followed up for 12 to 28 months with an average of 15.6 months. At the last follow-up, one forearm pronation was limited to 50 °. Elbow extension 0 ° ~ 10 °, an average of 4 °; flexion 120 ° ~ 145 °, an average of 133 °; pronation 70 ° ~ 90 °, an average of 75 °; rotation 80 ° ~ 90 °, an average of 87 °. Efficacy using Mackay clinical functional criteria, excellent in 8 cases, good in 7 cases, poor in 1 case. Conclusions The early operation of old Monteggia fracture in children, orthopedic ulnar osteotomy (or prolongation) and radial head open reduction and reduction are the key to restoring the normal structure of the brachioradialis and upper radioulnar joint. Depending on the stability of the radial head, Kirschner wire Needle short-term fixed, to create conditions for early recovery of joint function.