Lädermann Alexandre, Ceroni Dimitri, Lefèvre Yan, De Rosa Vincenzo, De Coulon Geraldo, Kaelin André
Department of Pediatric Orthopaedics, Children's Hospital, University Hospital of Geneva, rue Willy-Donzé 6, 1205, Geneva, Switzerland,
J Child Orthop. 2007 Oct;1(4):237-42. doi: 10.1007/s11832-007-0039-z. Epub 2007 Aug 29.
The treatment of an unrecognized Monteggia lesion continues to pose a therapeutic challenge, as evidenced by the variety of surgical techniques described. Moreover, there are high complication and redislocation rates following surgery. This report concerns a surgical technique to reduce a chronic dislocation of the radial head utilizing an ulnar osteotomy and internal fixation.
Six consecutive cases of missed Monteggia lesions were treated in our institution between August 2001 and September 2003. Patient mean age was 6.5 (range 4-8) years, and the mean interval between injury and surgical procedure was 17 (range 1-49) months. Surgery consisted of an ulnar osteotomy with angulation and lengthening, bone grafting at the osteotomy site, and internal fixation. Open reduction of the radial head, repair or reconstruction of the annular ligament or temporary fixation of the radial head with a transarticular wire was not undertaken. Cast immobilization with the forearm in neutral rotation was maintained for 2 weeks.
There was one case of nonunion. At an average follow-up of 3 (range 1.5-4.4) years, all patients had regained painless function of the forearm, good range of elbow and forearm motion, and maintenance of the radial head reduction.
Both angulation and elongation of the ulna are required to allow for reduction of the radial head. We do not see any indication for procedures directed at the radio-capitellar joint.
未被识别的孟氏骨折的治疗仍然是一个治疗挑战，多种描述的手术技术就证明了这一点。此外，手术后并发症和再脱位率很高。本报告涉及一种利用尺骨截骨术和内固定来复位桡骨头慢性脱位的手术技术。
2001年8月至2003年9月期间，我们机构连续治疗了6例漏诊的孟氏骨折病例。患者平均年龄为6.5岁（范围4 - 8岁），受伤与手术之间的平均间隔为17个月（范围1 - 49个月）。手术包括尺骨截骨术，伴有成角和延长，在截骨部位植骨，以及内固定。未进行桡骨头切开复位、环状韧带修复或重建或用经关节钢丝临时固定桡骨头。前臂保持中立旋转位石膏固定2周。
有1例骨不连。平均随访3年（范围1.5 - 4.4年），所有患者前臂均恢复无痛功能，肘关节和前臂活动范围良好，桡骨头复位得以维持。
尺骨的成角和延长对于桡骨头的复位都是必要的。我们认为针对桡肱关节的手术没有任何指征。
