CAJ | 학술논문

目的探讨儿童头颈分离型类孟氏骨折的受伤机制、治疗方法和疗效.方法回顾性分析2000年1月至2013年12月收治的15例儿童头颈分离型骨折的资料.男4例,女11例;左侧11例,右侧4例.受伤时年龄5.1～13.0岁(平均8.7岁).此类损伤的特点为尺骨干骨折伴桡骨颈骨折,桡骨头颈分离移位,肱桡关节保持完好,但桡骨纵轴的延长线偏离了肱骨小头的中心.根据骨折移位和成角的方向分型:工型定义为尺骨骨折端向尺掌侧成角,桡骨近侧干骺端向尺掌侧移位,共9例.Ⅱ型与Ⅰ型相反,成角和移位方向均指向桡背侧,共6例.尺骨骨折采用钢板、克氏针或弹性髓内针固定,桡骨颈骨折采用克氏针或弹性髓内针固定.术后根据X线片评估骨折复位效果,末次随访时按Bruce-Harvey-Wilson评分系统进行疗效评定.结果术后随访11～60个月(平均27个月).X线片评价尺骨骨折的复位效果:优13例,良2例.桡骨颈骨折采用Métaizeau评价标准:优14例,良1例.末次随访时按Bruce-Harvey-Wilson评分系统评定疗效:优13例,良1例,中1例.术后出现桡骨头骺缺血坏死改变1例,桡骨颈干骺端膨大1例.结论儿童头颈分离型类孟氏骨折受伤机制特殊,只要及时诊断和治疗、尺骨骨折坚强固定、桡骨颈骨折解剖复位、术后早期开始功能锻炼,均可获得满意的预后,并发症较少.
목적 탐토인동두경분리형류맹씨골절적수상궤제、치료방법화료효.방법 회고성분석2000년1월지2013년12월수치적15례인동두경분리형골절적자료.남4례,녀11례;좌측11례,우측4례.수상시년령5.1～13.0세(평균8.7세).차류손상적특점위척골간골절반뇨골경골절,뇨골두경분리이위,굉뇨관절보지완호,단뇨골종축적연장선편리료굉골소두적중심.근거골절이위화성각적방향분형:공형정의위척골골절단향척장측성각,뇨골근측간후단향척장측이위,공9례.Ⅱ형여Ⅰ형상반,성각화이위방향균지향뇨배측,공6례.척골골절채용강판、극씨침혹탄성수내침고정,뇨골경골절채용극씨침혹탄성수내침고정.술후근거X선편평고골절복위효과,말차수방시안Bruce-Harvey-Wilson평분계통진행료효평정.결과 술후수방11～60개월(평균27개월).X선편평개척골골절적복위효과:우13례,량2례.뇨골경골절채용Métaizeau평개표준:우14례,량1례.말차수방시안Bruce-Harvey-Wilson평분계통평정료효:우13례,량1례,중1례.술후출현뇨골두후결혈배사개변1례,뇨골경간후단팽대1례.결론 인동두경분리형류맹씨골절수상궤제특수,지요급시진단화치료、척골골절견강고정、뇨골경골절해부복위、술후조기개시공능단련,균가획득만의적예후,병발증교소.
Objective To explore the injury mechanism,treatment and prognosis of head-neck separation type among Monteggia equivalent fractures in children.Methods A retrospective study was conducted for 15 children of head-neck separation type fractures treated between January 2000 to December 2013.There were 3 boys and 12 girls with an average age of 8.7 (5.1-13) years.The injuries were located at left (n =11) and right (n =4) sides.The lesion was characterized by a fracture of ulnar diaphysis with a separated fracture of radial neck without a dislocation of radial head.And a line appeared through the longitudinal axis of radius off the center of capitellum.The classification was based on the direction of displacement and angulation of fractures.Nine cases belonged to type Ⅰ with an ulnar fracture with ulnar and palmar angulation plus radial neck fracture with ulnar and palmar displacement of distal end.And another 6 cases were classified as type Ⅱ with a direction of fracture displacement was opposite to that of type Ⅰ.The fractures of ulna were fixed with plate,Kirschner wire or elastic stable intramedullary nail.And the fractures of radial neck were fixed with Kirschner wire or elastic stable intramedullary nail.Reduction was evaluated by postoperative radiology and the therapeutic outcomes were assessed by the scheme of Bruce-Harvey-Wilson.Results The average follow-up period was 27 (11-60) months.The postoperative radiographs were used to evaluate the reductions of ulnar fractures.And the outcomes were good (n =13) and fair (n =2).According to the M taizeau criteria,the outcomes of radial neck fracture were good (n =14) and fair (n =1).According to the Bruce-Harvey-Wilson scoring system,the efficacies were excellent (n =13),good (n =1) and fair (n =1) at the last follow-up.Avascular necrosis occurred in 1 case and another case showed bulk formation of proximal metaphysis.Conclusions The head-neck separation type among Monteggia equivalent fractures have unique mechanisms.Timely diagnosis,prompt reduction,rigid fixation of ulnar fracture,anatomical reduction of radial neck fracture and early exercises may achieve a fair prognosis with fewer complications.