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[目的]观察探讨仅切开复位、尺骨截骨矫形外固定不行环状韧带重建治疗陈旧性孟氏骨折的临床疗效。[方法]本组16例平均年龄6.5岁(3岁6个月~12岁3个月),BadoⅠ型15例,BadoⅢ1例,病程平均为7.8个月(1个月~3年)。5例患儿伴有桡神经深支损伤。所有患儿均仅行了切开复位、尺骨截骨矫形外固定,平均随访18.5个月(12~38个月)。[结果]所有患者得到随访,其中12例患儿肘关节功能完全恢复。3例出现延迟愈合,有1例出现脱位复发,二期再次手术治疗。屈伸弧度从术前平均的100°提高到术后的132°,旋转弧度从术前176°提高到165°。按照Kim评分系统[1],其中12例为优、3例良好、1例差。5例伴有桡神经深支症状的患儿在术后12个月之内得到完全恢复。[结论]应用切开复位、尺骨截骨矫形外固定而不行环状韧带重建治疗陈旧性孟氏骨折减少了手术步骤,具有相对减少了手术时间、效果好、创伤小等优点,是治疗陈旧性孟氏骨折的有效方法。
[Objective] To observe the curative effect of open reduction, ulnar osteotomy and external fixation without ligament annuloplasty in the treatment of old Monteggia fracture. [Method] The average age of the 16 patients was 6.5 years old (3 years 6 months to 12 years old 3 months), 15 cases of Bado Ⅰ type and 1 case of Bado Ⅲ. The average course of disease was 7.8 months (1 month to 3 years). 5 cases of children with deep radial nerve injury. All patients underwent open reduction and external fixation of the ulnar osteotomy. The average follow-up was 18.5 months (range, 12 to 38 months). [Results] All the patients were followed up, of which 12 cases had complete recovery of elbow function. Three cases showed delayed healing, one case had dislocation recurrence and two cases had reoperation. The flexion and extension radians increased from 100 ° preoperatively to 132 ° postoperatively, and the rotation radian increased from 176 ° preoperatively to 165 °. According to Kim’s score system [1], 12 were excellent, 3 were good and 1 was poor. Five cases of children with deep branch of radial nerve symptoms were completely recovered within 12 months after operation. [Conclusion] Applying open reduction and external fixation of the ulna and osteotomy without annular ligament reconstruction to treat the old Monteggia fracture reduces the surgical procedure, has the advantages of relatively reducing the operation time, good effect and small trauma, and is an ideal method to treat the obsolete Monteggia fracture effective method.