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目的探讨采用一种改良术式治疗陈旧性孟氏骨折的临床疗效。方法 2006年3月-2013年12月,采用改良扩大切取前臂带蒂深筋膜瓣重建环状韧带和修复肘部桡侧副韧带复合体,尺骨截骨延长、骨痂回植钢板内固定术治疗40例陈旧性孟氏骨折患儿。其中男26例,女14例;年龄2~10岁,平均4岁。致伤原因:摔伤24例,交通事故伤8例,高处坠落伤8例。均为单侧伸直型骨折;病程2~11个月,平均4个月。合并桡神经麻痹4例。结果术后患儿切口均Ⅰ期愈合,无桡神经麻痹、肌筋膜室综合征、手部伸肌肌力下降等早期并发症发生。患儿均获随访,随访时间1~5年,平均2.5年。X线片示骨折均愈合,愈合时间10~20周,平均15周。随访期间3例发生再脱位,无手部肌肉粘连致手功能障碍及桡骨小头瓶颈状改变发生。末次随访时根据Mackay等功能评定标准评定,获优32例,良5例,差3例,优良率92.5%。结论采用改良术式治疗陈旧性伸直型孟氏骨折,肱桡关节匹配程度良好,可不作内固定处理,临床疗效良好。
Objective To investigate the clinical efficacy of an improved surgical treatment of old Monteggia fracture. Methods From March 2006 to December 2013, a modified and expanded approach was used to reconstruct the ligaments and repair the elbow radial collateral ligament complex, the ulnar osteotomy was extended, the callus replanted plate fixation Treatment of 40 cases of old Monteggia fracture in children. Including 26 males and 14 females; aged 2 to 10 years old, average 4 years old. Cause of injury: falls in 24 cases, traffic accident in 8 cases, height fall injury in 8 cases. All unilateral straight fractures; duration of 2 to 11 months, an average of 4 months. Radial nerve paralysis in 4 cases. Results All incisions were healed by first intention without any complications of radial nerve paralysis, myofascial compartment syndrome and decreased hand extensor muscle strength. Children were followed up for 1 to 5 years, an average of 2.5 years. X-ray showed fracture healing, healing time 10 to 20 weeks, an average of 15 weeks. During the follow-up period, 3 cases occurred re-dislocation, hand-induced hand muscle dysfunction and radial head bottleneck occurred. According to Mackay and other functional assessment criteria at the final follow-up, 32 cases were excellent, 5 good and 3 poor, the excellent and good rate was 92.5%. Conclusion Modified surgical treatment of old straight Monteggia fractures, brachioradialis joint matching is good, may not be treated with internal fixation, the clinical efficacy is good.