David-West Kenneth S, Wilson Neil I L, Sherlock David A, Bennet George C
Department of Orthopaedic Surgery, The Royal Hospital for Sick Children, Yorkhill, Glasgow G3 8SJ, UK.
Injury. 2005 Oct;36(10):1206-9. doi: 10.1016/j.injury.2004.12.033. Epub 2005 Mar 28.
The classical Monteggia injury comprises a dislocation of the radial head with an associated fracture of the ulna. In the variant type, there is no ulnar fracture merely plastic deformation. We performed a retrospective study of all Monteggia injuries from 1992 to 2001. A total of 39 were reviewed, of which 8 were missed (1 classical and 7 variant). Of those, five were male and three female with a mean age of 6.3 years. The mean follow-up was 2.5 years, with a mean interval between injury and diagnosis of 33.5 weeks. Two Monteggia injuries diagnosed within 4 weeks were successfully treated by closed manipulation. The other six required ulnar osteotomy, repair of the annular ligament and stabilisation of the radial head with a transcapitellar pin. A protocol for the diagnosis of Monteggia injuries is described. Doubtful cases require an immediate review since early treatment improves the outcome. Acceptable clinical and radiological results in late diagnosed Monteggia injuries can result from ulnar osteotomy, open reduction of the radial head with repair of the annular ligament and transcapitellar pin stabilisation of the reduced radial head.
经典型孟氏骨折包括桡骨头脱位并伴有尺骨骨折。在变异型中，没有尺骨骨折，仅有塑性变形。我们对1992年至2001年期间所有的孟氏骨折进行了一项回顾性研究。共回顾了39例，其中8例漏诊（1例经典型和7例变异型）。这些患者中，5例为男性，3例为女性，平均年龄6.3岁。平均随访2.5年，受伤至诊断的平均间隔时间为33.5周。4周内诊断的2例孟氏骨折通过闭合手法复位成功治疗。另外6例需要行尺骨截骨术、修复环状韧带并用经肱骨头钢针固定桡骨头。本文描述了孟氏骨折的诊断方案。可疑病例需立即复查，因为早期治疗可改善预后。对于晚期诊断的孟氏骨折，通过尺骨截骨术、桡骨头切开复位并修复环状韧带以及用经肱骨头钢针固定复位后的桡骨头，可获得可接受的临床和影像学结果。
