关节造影辅助复位单边外固定儿童新鲜孟氏骨折△

Arthrography assisted reduction and fixation with unilateral external frame for fresh Monteggia fractures in children

摘要:

[目的]评价关节造影辅助单边外固定架在新鲜儿童孟氏骨折中的临床效果。[方法]本研究共纳入 16 例新鲜儿童孟氏骨折患儿，术中给予骨折复位，应用关节造影评估复位效果，行单边外固定架固定。[结果] 所有患儿均顺利完成手术， 无相关并发症。造影时间平均 (4.55±1.03) min；手术时间平均 (32.56±4.45) min；出血量平均 (8.25±3.36) ml，主动活动时间术后(4.85±0.67)周。16 例患儿均获得随访 6~18 个月。与术后 6 周相比，末次随访时肘关节屈伸 ROM 及前臂旋转 ROM 均显著增加(P＜0.05)。根据 Mackay 疗效评定标准，优良率 100%；术后影像显示，骨折复位质量优良率 100%。术后 6 周及末次随访时全部患者肱桡关节对合正常，尺骨力线良好，无成角。[结论]对于尺骨干长斜形及粉碎性儿童新鲜孟氏骨折，复位术中关节造影和单边外固定架固定具有其操作简单，创伤小，治疗可靠的优点 。

Abstract:

[Objective] To evaluate the clinical outcomes of arthrography assisted reduction combined with fixation by unilateral exter- nal fixator for fresh Monteggia fractures in children. [Methods] A total of 16 children with fresh Monteggia fractures were enrolled in this study. Intraoperative fracture reduction was performed with arthrography used to evaluate the reduction effect, followed by the fixation with unilateral external frame. [Results] All the children were successfully operated on without related complications, while with angiography time of (4.55±1.03min) , operation time of (32.56±4.45) min, blood loss of (8.25±3.36) ml, and the time to return active motion of (4.85± 0.67) weeks. All 16 patients were followed up for 6~18 months, and the elbow flexion- extension range of motion (ROM) and forearm rota- tion ROM significantly increased at the latest follow-up compared with those at 6 weeks after operation (P＜0.05) . According to Mackay's criteria, the excellent and good rate of the clinical outcome was 100%. Postoperative imaging showed that the good rate of fracture reduction was 100%. At 6 weeks postoperatively and the latest follow-up, all patients got normal humeroradial congrunce and proper ulnar alignment without angulation. [Conclusion] Arthrography assisted reduction combined with fixation by unilateral external fixator has advantages of simple operation, little iatrogenic trauma and reliable treatment outcomes for Monteggia fractures with long oblique ulnar diaphysis fracture in children.