摘要
目的利用部分肱二头肌肌腱及肌筋膜转位修复环状韧带的方法提高儿童陈旧性孟氏骨折的疗效。方法2010年2月至2017年1月,采取肱二头肌肌腱部分及肌筋膜转位修复环状韧带手术方法治疗儿童陈旧性孟氏骨折11例,男7例,女4例,年龄4岁2个月至12岁3个月,平均7岁3个月。BadoⅠ型8例,BadoⅢ型3例,手术距离骨折发生时间2~11个月,平均5个月。术后随访5~15个月,平均随访7个月。按照Mackay功能评定标准进行疗效评价。结果所有患儿术后未出现桡骨头再次脱位或半脱位。1例患儿出现关节活动疼痛症状。患肢的肘关节屈伸及前臂旋转活动度较术前明显改进,肘关节屈伸活动度从术前平均的94.45°提高到术后的122.55°,前臂旋转活动度从术前平均99.82°增加至148.09°。按照Macky标准优良率达90.9%,其中7例为优,3例良好,1例差。随访拍摄X线片观察:尺骨截骨断端愈合满意,无骨不连、异位骨化、内固定松动脱出、关节退行性变及发育畸形等并发症,术后半年左右取出内固定钢板。2例伴有桡神经深支损伤症状的患儿在术后半年完全恢复。结论利用部分肱二头肌肌腱及肌筋膜转位修复环状韧带治疗儿童陈旧性孟氏骨折较传统的环状韧带重建手术具有手术简单、并发症少、术后关节功能恢复快等优点,是一种有效的治疗方法。
Objective To explore the efficacies of annular ligament repair by biceps tendon for chronic Monteggia fracture in children.Methods From February 2010 to January 2017,a total of 11 children with chronic Monteggia fractures were recruited.All of them underwent annular ligament repair by biceps tendon and ulnar osteotomy.There were 7 boys and 4 girls with an average age of 87 (50-147)months.The clinical types were Bado Ⅰ (n=8)and Bado Ⅲ(n=3).The average follow-up time from injury to operation was 5(2-11)months.And the average follow-up period was 7(5-15) months.The outcomes were evaluated by the Mackay's scoring system.Results Among them,there was no onset of redislocation or subluxation during the follow-up period.Only one patient experienced elbow pain.Elbow flexion,extension and forearm rotation were significantly improved postoperatively.The average degree of elbow flexion and extension were improved from preoperative 94.55 to postoperative 122.55 and the average degree of forearm rotation increased from preoperative 99.82 to postoperative 148.09.The clinical outcomes were excellent or good (90.9%)according to the Mackay's criteria.And the functional outcomes were excellent (n =7),good (n =3)and poor (n = 1).Follow-up radiography showed that ulnar osteotomy was healed for all cases and there were no such complications as bone nonunion,heterotopic ossification,loosening plate,degeneration or malfomation.Internal fixation was removed at 6months postoperatively.Two symptomatic cases of deep branch of radial nerve recovered.Conclusions Annular ligament repair by biceps tendon is effective for chronic Monteggia fracture in children.It offers the advantages of handling simplicity, fewer complications and faster recovery of joint function.
作者
张同庆
慕明章
唐伟
王清防
孙涛
贵浩然
孙振中
岳俊伊
姜小艳
朱咏梅
ZhangTongqing;Mu Mingzhang;Tang Wei;Wang Qingf ang;Sun Tao;Gui Haoran;Sun Zhenzhong;Yue Junyi;J iang Xiaoyan;Zhu Yongmei(Department of Pediatric Orthopedics,Yantaishan Hospital,Yantai 264000,China)
出处
《中华小儿外科杂志》
CSCD
北大核心
2018年第11期821-824,共4页
Chinese Journal of Pediatric Surgery
