CAJ | 학술논문

目的探讨尺骨截骨后成角延长钢板内固定或单臂外固定两种方法治疗儿童陈旧性孟氏骨折的疗效及相关影响因素.方法回顾性分析2005年7月至2011年6月收治的儿童陈旧性孟氏骨折患儿19例,男11例,女8例.Bado Ⅰ型13例,Ⅲ型6例.按照尺骨截骨后固定方法分为钢板内固定组(12例,治疗时平均年龄为5.3岁,受伤时间平均为6.8个月；Bado Ⅰ型9例,Ⅲ型3例)和单臂外固定组(7例,治疗时平均年龄为11.8岁,受伤时间平均为16.6个月；Bado Ⅰ型4例,Ⅲ型3例).对两组患儿的年龄、受伤时间、术后并发症、肘关节与前臂旋转功能、骨折愈合时间等指标进行比较.结果 19例患儿均获随访,平均10个月(6～36个月).术后钢板内固定组1例发生桡骨头再脱位,单臂外固定组1例发生筋膜室综合征.钢板内固定组、单臂外固定组两组患儿除1例外,术后屈肘功能平均120°(110°～130°),前臂旋前功能均有15°(10°～20°)的受限.尺骨截骨成角延长后的愈合时间:钢板内固定组平均8周(6～15周),单臂外固定组平均22周(10～44周).按Nakamura等影像学评估标准:钢板内固定组优11例(图1),差1例；单臂外固定组7例均为优.结论尺骨截骨成角延长是治疗儿童陈旧性孟氏骨折矫正尺骨骨折后畸形的关键,截骨后的两种固定方法不同、目的相同.术前评估最重要:年龄小、受伤时间短患儿选择钢板内固定,而对年龄大、受伤时间长者选择单臂外固定.
목적 탐토척골절골후성각연장강판내고정혹단비외고정량충방법치료인동진구성맹씨골절적료효급상관영향인소.방법 회고성분석2005년7월지2011년6월수치적인동진구성맹씨골절환인19례,남11례,녀8례.Bado Ⅰ형13례,Ⅲ형6례.안조척골절골후고정방법분위강판내고정조(12례,치료시평균년령위5.3세,수상시간평균위6.8개월；Bado Ⅰ형9례,Ⅲ형3례)화단비외고정조(7례,치료시평균년령위11.8세,수상시간평균위16.6개월；Bado Ⅰ형4례,Ⅲ형3례).대량조환인적년령、수상시간、술후병발증、주관절여전비선전공능、골절유합시간등지표진행비교.결과 19례환인균획수방,평균10개월(6～36개월).술후강판내고정조1례발생뇨골두재탈위,단비외고정조1례발생근막실종합정.강판내고정조、단비외고정조량조환인제1예외,술후굴주공능평균120°(110°～130°),전비선전공능균유15°(10°～20°)적수한.척골절골성각연장후적유합시간:강판내고정조평균8주(6～15주),단비외고정조평균22주(10～44주).안Nakamura등영상학평고표준:강판내고정조우11례(도1),차1례；단비외고정조7례균위우.결론 척골절골성각연장시치료인동진구성맹씨골절교정척골골절후기형적관건,절골후적량충고정방법불동、목적상동.술전평고최중요:년령소、수상시간단환인선택강판내고정,이대년령대、수상시간장자선택단비외고정.
Objective To evaluate and compare the outcomes of missed Monteggia fractures in children treated with ulnar angulation-distraction osteotomy and plate fixation or external fixation.Methods Nineteen patients,including 11 boys and 8 girls who presented with missed Monteggia fracture,were reviewed from July 2005 to June 2011.Twelve children (Group A) were treated with ulna angulation osteotomy and plate fixation,and 7 eases (Group B) with ulna angulation-distraction osteotomy and external fixator.Thirteen patients were classified as type Bado Ⅰ,and six as type Bado Ⅲ.The age,the delay from injury to surgery,complications,elbow and forearm function,and the healing time of the osteotomy were compared.Results All 19 patients were followed up.The duration of missed dislocation was from 6 to 36 months (mean,10 months).Redislocation of the radiocapitellar joint occurred after surgery in one case in group A.Forearm compartment syndrome occurred in one case after surgery in group B.All patients,except one,regained full elbow flexion in group A and B,various forearm pronation limitation were noted in all patients (mean,15°).The average healing of osteotomy of group A and B was 8 weeks (6-15 weeks) and 22 weeks (10-44 weeks).Conclusion The ulnar angulation-distraction osteotomy could correct the ulnar deformity in children of missed Monteggia fractures,which is the key issue to be corrected.Both of the fixation strategies can obtain the same treatment results.Preoperative assessment is most important,plate internal fixation was recommended for young age and short delay cases,on the contrary,we prefer to choose external fixator.