儿童陈旧性孟氏骨折尺骨截骨内固定与非内固定比较

Comparison of ulnar osteotomy with and without internal fixation for old Monteggia fractures in children

摘要:

［目的］ 比较内固定与非内固定尺骨截骨治疗儿童陈旧性孟氏骨折的疗效。［方法］ 2018 年 7 月—2020 年 7 月，79 例儿童陈旧性孟氏骨折患者均接受尺骨截骨，肱桡关节复位和石膏外固定治疗。根据医患沟通结果，42 例术中对截骨行内固定，37 例术中未对截骨行内固定。比较两组围手术期、随访及影像资料。［结果］所有患者均顺利完成手术。非固定组手术时间、切口长度、透视次数、住院时间均显著优于固定组（P<0.05）。患者均获随访 12 个月以上，非固定组恢复术完全负重活动时间显著早于固定组（P<0.05）。随时间推移，两组患者前臂旋前、旋后、肘屈伸 ROM 及 Mayo 评分均显著增加（P<0.05），相应时间点，两组间上述指标的差异均无统计学意义（P>0.05）。影像方面，术后随时间推移，两组患者术后 RCL 对合与 RCC 程度均显著改善 （P<0.05）。末次随访时，非固定组的 RCL 对合与 RCC 程度均显著优于固定组 （P<0.05）。非固定组截骨影像愈合时间显著早于固定组 （P<0.05）。［结论］ 对于儿童陈旧性孟氏骨折手术治疗，尺骨截骨非内固定的临床效果优于截骨内固定。

Abstract:

[Objective] To compare the efficacy of ulna osteotomy with and without internal fixation for old Monteggia fractures in chil- dren. [Methods] From July 2018 to July 2020, a total of 79 children underwent ulnar osteotomy and open radiocapitellar reduction com- bined plaster cast fixation for old Monteggia fractures. According to preoperative doctor-patient communication, 42 children had osteotomy site fixed with internal implant (fixation group) , while the other 37 had osteotomy performed only without internal fixation (the non-fixation group). The perioperative, follow-up and imaging data of the two groups were compared. [Results] All patients had the operations complet- ed successfully. The non-fixation group proved significantly superior to the fixation group in terms of operation time, incision length, times of fluoroscopy, incision healing and hospital stay (P<0.05) . All the patients were followed up for more than 12 months. The non-fixation group resumed full weight-bearing activity significantly earlier than the fixation group (P<0.05) . Th range of motions (ROMs) , including pronation, supination, elbow flexion and extension, as well as Mayo elbow score significantly increased over time in both groups (P<0.05) , however, there were no statistically significant differences in abovesaid items between the two groups at any corresponding time points (P> 0.05) . Radiographically, the alignments in term of radiocapitellar line (RCL) and extent of radiocapitellar congruence (RCC) significantly improved in both groups over time (P<0.05) , which in the non-fixation group was significantly superior to those in the fixation group at the latest follow-up (P<0.05) . In addition, the non-fixation group got bony healing of the osteotomy site on images significantly earlier than the fixation group (P<0.05) . [Conclusion] The clinical outcomes of ulna osteotomy without internal fixation are considerably better than those with internal fixation in the surgical treatment of old Monteggia fractures in children.