摘要
目的探讨Henry入路前关节囊横切松解下移选择性后关节囊纵切桡骨头套入改良方法治疗儿童陈旧性孟氏骨折的疗效。方法2013年2月至2019年12月,采取肘关节后入路尺骨截骨矫形内固定、Henry入路前关节囊横切松解下移选择性后关节囊纵切桡骨头套入的手术方法治疗儿童陈旧性孟氏骨折29例。其中,男18例,女11例,年龄4岁3个月至13岁5个月,平均8岁4个月,BadoⅠ型20例,BadoⅢ型9例,手术距离骨折发生时间3~48个月,平均13个月,其中时间小于24个月组患儿21例,大于24个月组患儿8例,术后随访4~27个月,平均随访17个月。按照Mackay功能评定标准进行疗效评价。结果29例患儿术中予以尺骨截骨成角延长钢板内固定序贯肘关节前上方关节囊横切松解下移卡压环状韧带后进行肘关节屈伸活动稳定性测试,8例患儿屈肘关节时出现桡骨头前方脱位,其中受伤时间小于24个月的患儿1例,大于24个月的患儿7例,采取选择性后关节囊纵行切开松解环状韧带修复后桡骨头恢复稳定性。所有患儿术后未出现关节活动疼痛症状,无桡神经深支损伤症状。患肢的肘关节屈伸及前臂旋转活动度较术前明显改进,肘关节屈伸活动度术前平均的90.17°提高到术后的121.10°,前臂旋转活动度术前平均91.21°增加至121.55°。按照Macky标准优良率达100%,其中19例为优,10例良好。拍摄X线片随访观察:肱桡关节关系对应良好,尺骨截骨断端愈合满意,无骨不愈合、异位骨化、内固定松动脱出、桡骨头脱位或半脱位。结论肘关节Henry入路前关节囊横切松解下移选择性后关节囊纵切桡骨头套入方法治疗儿童陈旧孟氏骨折,其环状韧带再利用、操作创伤小、降低术后桡骨头再脱位风险等优点,是一种值得临床探讨的手术方法。
Objective To explore the efficacies of annular ligament repair plus selective posterior release of joint capsule by anterior elbow approach for old pediatric Monteggia fracture.Methods From February 2013 to December 2019,a total of 29 children with old Monteggia fractures were recruited.All of them underwent open reduction of radial head,osteotomy of ulna and annular ligament repair plus selective posterior release of joint capsule via Henry's approach.There were 18 boys and 11 girls with an average age of 100(51-161)months.The clinical types were Bado I(n=20)and BadoⅢ(n=9).The average follow-up time from injury to operation was 13(3-48)months,including(n=21,<24 months)and(n=8,>24 months).And the average follow-up period was 17(4-27)months.The outcomes were evaluated by the Mackay's scoring system.Results After open reduction of radial head and ulnarosteotomy angulation by plate fixation,the tests of elbow flexion and extension were performed before repairing.There was anterior dislocation of radial head after elbow flexion(n=1,<24 months)and(n=7,>24 months)and stability of radial head was restored by selective longitudinal posterior release of joint capsule.There was no symptom of elbow pain or injury of deep branch of radial nerve.Elbow flexion,extension and forearm rotation significantly improved postoperatively.The average degrees of elbow flexion and extension improved from preoperative 90.17 to postoperative 121.10 and the average degree of forearm rotation spiked from preoperative 91.21 to postoperative 121.55.The clinical outcomes were excellent or decent(100%)according to the Mackay's criteria.And the functional outcomes were excellent(n=19),decent(n=10)and poor(n=0).Follow-up radiography indicated that ulnarosteotomy was healed for all cases and there were no such complications as bone nonunion,heterotopic ossification,loosening plate,redislocation or subluxation.Conclusions The modified method of annular ligament repair plus selective posterior release of joint capsule via Henry's approach is efficac
作者
张同庆
慕明章
唐伟
王清防
孙政文
成功
孙涛
贵浩然
马玉鹏
仇超
Zhang Tongqing;Mu Mingzhang;Tang Wei;Wang Qingfang;Sun Zhengwen;Cheng Gong;Sun Tao;Gui Haoran;Ma Yupeng;Qiu Chao(Department of Pediatric Orthopedics,MountainYantai Hospital,Yantai 264000,China)
出处
《中华小儿外科杂志》
CSCD
北大核心
2020年第8期739-743,共5页
Chinese Journal of Pediatric Surgery
