小型外固定架治疗儿童新鲜孟氏骨折△

Mini external fixator for fresh Monteggia fractures in children

摘要:

［目的］评价小型外固定架在儿童新鲜孟氏骨折中的应用效果。［方法］本研究共纳入 12 例新鲜儿童孟氏骨折患儿， 术中给予骨折复位，行小型外固定架固定，应用关节造影评估复位效果，术后给予前臂旋后位石膏固定。［结果］所有患儿均顺利完成手术，无相关并发症。12 例患儿均获得随访 6~12 个月。末次随访时肘关节屈伸活动范围（range of motion, ROM）及前臂旋转 ROM 均较术后 4 周显著增加（P<0.05）。末次随访时根据 Mayo 肘关节评分标准，临床结果优 11 例，良 1 例，优良率 100%。影像方面，术后 12 例均达到满意肱桡对合和尺骨力线恢复，末次随访时，肱桡对合和尺骨力线均无改变（P>0.05）。术后 4 周复查 X 线片断端均可见骨痂形成，影像骨折愈合时间 8~12 周。［结论］对于儿童新鲜孟氏骨折采用小型外固定架固定为有效的治疗方法，其操作简单，创伤小。

Abstract:

[Objective] To evaluate the clinical outcomes of mini external fixator for fresh Monteggia fracture in children. [Methods] A total of 12 children with Monteggia fractures were enrolled in this study. Intraoperative fracture reduction and external fixation with a mini frame were conducted in all the children, additionally elbow arthrography intraoperatively was used if necessary to evaluate the reduction, followed by postoperative forearm plaster cast in supination. [Results] All the children were successfully operated without related complica- tions, and were followed up for 6~12 months. The range of motion (ROM) of the elbow flexion-extension and the ROM of forearm rotation were significantly increased at the last follow-up compared with those at 4 weeks after operation (P＜0.05) . According to the Mayo elbow score at the latest follow- up, the clinical outcomes were marked as excellent in 11 cases and good in 1 case, with excellent/good rate of 100%. Radiographically, all the 12 patients achieved satisfactory recovery of humeroradial congruence and ulna alignment after surgery, which remained unchanged until the latest follow-up (P＞0.05) . The X-ray films showed callus formation at fracture site as early as 4 weeks after the operation, with sound fracture healing time on the images ranged from 8 to 12 weeks. [Conclusion] This mini external fixator is an effective treatment for fresh Monteggia fracture in children, with benefits of simplifying operation and minimizing iatrogenic trauma.