CAJ | 학술논문

目的：对儿童孟氏骨折环状韧带损伤后于急性期修补和前臂筋膜重建两种不同治疗方法的临床效果进行评价，探讨影响孟氏骨折预后的因素。方法回顾分析2008年06月～2013年09月住院的43例因环状韧带损伤而致闭合复位失败的急性期儿童孟氏骨折，随机分成2组，行切开手术治疗，尺桡骨复位固定，22例作环状韧带原位修补（环状韧带原位修补组），21例以前臂深筋膜条重建环状韧带（环状韧带重建组）。随访测量患侧肘关节屈伸/旋转活动范围，并测出对侧正常肘关节屈伸/旋转活动范围，作运动功能得分（motion score)，2组间进行比较。结果所有病例经6个月～5年9个月（平均2.9年）随访，环状韧带原位修补组肘关节屈伸、旋转活动功能及运动得分均优于环状韧带重建组（P＜0.05）。结论儿童孟氏骨折急性期如因环状韧带损伤而致闭合复位失败，应尽量行环状韧带原位修补，如无法修补，用前臂深筋膜代替环状韧带，仍能期望良好的治疗效果。
목적：대인동맹씨골절배상인대손상후우급성기수보화전비근막중건량충불동치료방법적림상효과진행평개，탐토영향맹씨골절예후적인소。방법회고분석2008년06월～2013년09월주원적43례인배상인대손상이치폐합복위실패적급성기인동맹씨골절，수궤분성2조，행절개수술치료，척뇨골복위고정，22례작배상인대원위수보（배상인대원위수보조），21례이전비심근막조중건배상인대（배상인대중건조）。수방측량환측주관절굴신/선전활동범위，병측출대측정상주관절굴신/선전활동범위，작운동공능득분（motion score)，2조간진행비교。결과소유병례경6개월～5년9개월（평균2.9년）수방，배상인대원위수보조주관절굴신、선전활동공능급운동득분균우우배상인대중건조（P＜0.05）。결론인동맹씨골절급성기여인배상인대손상이치폐합복위실패，응진량행배상인대원위수보，여무법수보，용전비심근막대체배상인대，잉능기망량호적치료효과。
Objective To evaluate the clinical outcome in acute children's Monteggia fracture after annular ligament repaired or reconstruction and to inquire into the factors affecting prognosis of Monteggia fracture. Methods A retrospective study for 43 patients of acute Monteggia's fractures in children, who were hospitalized in our hospital from June 2008 to September 2013, failed in conservative treatment. Two groups were formed by random assignment, underwent operation for ulnar fracture reduction and fixation, 22 cases were treated by annular ligament repaired and 21 cases underwent annular ligament reconstruction with the deep forearm fascia. We measured the injured elbow flexion and extension/rotation range, and measured the activities of the contralateral normal elbow flexion and extension/rotation range during follow-up. The motion score of each patient was calculated and compared between two groups. Results All patients were followed-up for 6 months to 5 years 9 months (average 2.9 years), the elbow motion range and the motion score of annular ligament repaired group is larger than the annular ligament reconstruction group (P<0.05). Conclusion The acute Monteggia's fracture in children with annular ligament damaged should be treated by annular ligament repaired. However, when it is difficult to repaired, to replace the annular ligament with a forearm deep fascia can still expect good results.