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[目的]探讨应用Ilizarov外固定架治疗儿童陈旧性孟氏骨折的疗效。[方法]2012年3月~2013年10月应用改良Ilizarov外固定架微创治疗儿童陈旧性孟氏骨折13例,年龄2~13岁,平均7.6岁;在尺骨适宜部位以直径2.5 mm螺纹半针固定3组半环形固定器,距尺骨鹰嘴3~5 cm处作尺骨横断截骨,术后1周沿尺骨长轴行纵向延长,每日1 mm,分6次完成,骨延长至肱桡关节间隙达5 mm时,停止尺骨纵向延长,依靠Ilizarov外固定器三组铰链不等距延长,使尺骨向与桡骨头脱位相反方向成角,桡骨头即缓慢复位。[结果]全部患儿均获随访,尺骨截骨处平均3.2个月骨性愈合,桡骨头复位稳定;肘关节伸屈和前臂旋转功能均有显著改善,肘关节伸屈在0°~130°,前臂旋前45°~85°,前臂旋后60°~90°。根据Mackay功能评定标准:优11例,良2例。[结论]应用Ilizarov技术微创治疗儿童陈旧性孟氏骨折有以下优点:(1)创伤小,尺骨背侧仅有1~1.5 cm切口;(2)操作方便,全部螺纹半针均在皮下可触及的尺骨上固定;(3)桡骨头复位稳定,随诊患儿无1例复发;(4)肘关节伸屈和前臂旋转功能恢复满意。本疗法值得临床推广应用。
[Objective] To investigate the curative effect of Ilizarov external fixator on old Monteggia fracture in children. [Methods] From March 2012 to October 2013, 13 patients with aged Monteggia fracture were treated with modified Ilizarov external fixator. They were aged from 2 to 13 years (average 7.6 years). In the appropriate part of the ulna, 2.5 mm thread half Three sets of semi-circular anchors were fixed at 3 ~ 5 cm from the olecranon of the ulna for transverse osteotomy. One week after operation, the long axis of the ulna was longitudinally extended 1 mm per day for 6 times. The bone was extended to the humerus Radial joint space up to 5 mm, to stop the longitudinal extension of the ulna, relying on the Ilizarov external fixator three groups of unequal extension of the hinge, so that the ulna and radial head dislocation in the opposite direction angulation, radial head that is slowly reset. [Results] All patients were followed up. The ulna osteotomy had an average of 3.2 months of bony union and radial head reduction and stabilization. Elbow flexion and flexion of the forearm were significantly improved. Elbow flexion ranged from 0 ° to 130 ° , Forearm rotation 45 ° ~ 85 °, forearm rotation after 60 ° ~ 90 °. According to Mackay functional assessment criteria: excellent in 11 cases, good in 2 cases. [Conclusion] The minimally invasive treatment of children with Monteggia fracture by Ilizarov technique has the following advantages: (1) The trauma is small with only 1 ~ 1.5 cm incision on the dorsal side of the ulna; (2) The operation is convenient and all the half-needle threads are subcutaneously (3) The radial head was stable and no recurrence was found in the follow-up children. (4) Elbow flexion and extension and forearm rotation were restored satisfactorily. The therapy worthy of clinical application.