摘要
目的分析向后孟氏骨折的不典型影像学特征并探讨其诊断与治疗效果。方法回顾性分析2019年7至2020年12月北京积水潭医院创伤骨科收治的12例影像学特征不典型的向后孟氏骨折患者资料, 男7例, 女5例;年龄18~65岁, 平均46.5岁;肘关节X线及CT影像学特征:上尺桡脱位不明显;在冠状突水平或临近冠状突水平尺骨骨折端前方可见三角形或四边形蝶形骨片;肱桡关节正常或桡骨头向前脱位, 但桡骨头呈粉碎骨折、桡骨头前缘骨折或桡骨颈向后成角骨折。尺骨近端骨折采用鹰嘴解剖锁定钢板或辅助克氏针张力带固定, 尺骨冠状突骨折采用克氏针、拉力螺钉或微型钢板固定, 桡骨头骨折采用埋头钉、微型钢板或桡骨头置换, 外侧副韧带损伤严重者带线锚钉修复。记录患者骨折愈合时间、并发症及末次随访时肘关节活动度、Mayo肘关节功能评分(MEPS)。结果 12例患者术后获6~28个月(平均16.4个月)随访。所有患者骨折均获骨性愈合, 愈合时间12~19周, 平均14.6周。末次随访时肘关节屈伸活动度75°~145°, 平均100.5°;前臂旋转度为80°~155°, 平均132.0°;MEPS为50~100分, 平均86.2分, 优5例, 良4例, 可2例, 差1例。3例患者发生肘关节僵硬。结论总结向后孟氏骨折的不典型影像学特征有助于准确诊断, 并提高治疗效果。
Objective To discuss the atypical radiological features of posterior Monteggia fracture and appropriate treatment of the fracture.Methods A retrospective study was conducted of the 12 patients who had been treated for posterior Monteggia fracture with atypical radiological features at Department of Orthopaedics and Traumatology,Beijing Jishuitan Hospital from July 2019 to December 2020.They were 7 males and 5 females,aged from 18 to 65 years(mean,46.5 years).Their elbow X-ray and CT scan features included unidentified upper ulnoradial dislocation,presence of triangular or quadrilateral butterfly fracture pieces in front of the fracture end at the level of ulnar coronal process,normal humeroradial joint or forward dislocated radial head,comminuted fracture or anterior edge fracture of the radial head,or backward angulated fracture of the radial neck.The proximal ulnar fractures were fixated with olecranon anatomical locking compression plate or with assistant kirschner wire and tension band fixation;the ulnar coronoid process fractures were fixated with kirschner wire or lag screws or a mini-plate;the radial head fractures were fixated with headless compressing screws or a mini-plate or treated with radial head replacement;the severe injury to the radial collateral ligament was repaired with a suture anchor.Fracture union time,complications and range of elbow motion at the final follow-up were recorded.Elbow function was assessed by Mayo elbow performance score(MEPS).Results All patients were followed up for 6 to 28 months(mean,16.4 months).All fractures achieved bony union after 12 to 19 weeks(14.6 weeks).The final follow-ups revealed the following:the range of elbow flexion and extension ranged from 75°to 145°,averaging 100.5°;the range of forearm rotation ranged from 80°to 155°,averaging 132.0°;the MEPS ranged from 50 to 100 points,averaging 86.2 points and yielding 5 excellent,4 good,2 fair and 1 poor cases.Elbow stiffness developed in 3 cases.Conclusion Understanding the atypical radiological features o
作者
袁伟杰
公茂琪
Yuan Weijie;Gong Maoqi(Department of Orthopaedics and Traumatology,Beijing Jishuitan Hospital,Beijing 100035,China;Department of Orthopaedics and Traumatology,The Third Hospital of Shijiazhuang,Shijiazhuang 050011,China)
出处
《中华创伤骨科杂志》
CAS
CSCD
北大核心
2022年第5期442-445,共4页
Chinese Journal of Orthopaedic Trauma
关键词
肘关节
骨折固定术
疾病特征
后孟氏骨折
Elbow joint
Fracture fixation
Disease Attributes
Posterior Monteggia fracture
