Nakamura Koichi, Hirachi Kazuhiko, Uchiyama Shigeharu, Takahara Masatoshi, Minami Akio, Imaeda Toshihiko, Kato Hiroyuki
Department of Orthopaedic Surgery, Shinshu University School of Medicine, 3-1-1 Asahi, Matsumoto 390-8621, Japan.
J Bone Joint Surg Am. 2009 Jun;91(6):1394-404. doi: 10.2106/JBJS.H.00644.
There have been few reports on the long-term outcomes after the operative treatment of missed Monteggia fracture-dislocations in children. The purpose of the present study was to evaluate the long-term clinical and radiographic outcomes after open reduction for the treatment of a missed Monteggia fracture-dislocation.
We postoperatively investigated the clinical and radiographic outcomes for twenty-two children with a missed Monteggia fracture. The study group included fourteen boys and eight girls who had had a mean age of ten years (range, four years to fifteen years and eleven months) at the time of open reduction. Each patient had been managed with open reduction of the radial head combined with a posterior bending elongation ulnar osteotomy and anular ligament reconstruction. Clinical and radiographic outcomes were reviewed over a mean duration of follow-up of seven years.
The postoperative Mayo Elbow Performance Index at the time of follow-up ranged from 65 to 100, with nineteen excellent, two good, one fair, and no poor results. The radial head remained in a completely reduced position in seventeen patients and was subluxated in five patients at the time of the latest follow-up. In four patients, osteoarthritic changes were observed at the radiohumeral joint. Radiographically, there were fifteen good, seven fair, and no poor results. A good radiographic result was obtained in all of the patients who had undergone open reduction within three years after the injury or before the age of twelve years, whereas a fair result was obtained in seven of the remaining eight patients.
If open reduction for the treatment of a missed Monteggia fracture is performed when the patient is less than twelve years of age or within three years after the injury, good long-term clinical and radiographic outcomes can be expected.
儿童孟氏骨折脱位漏诊后的手术治疗长期疗效报道较少。本研究旨在评估切开复位治疗儿童孟氏骨折脱位漏诊后的长期临床及影像学疗效。
我们对22例孟氏骨折漏诊患儿的临床及影像学疗效进行了术后调查。研究组包括14名男孩和8名女孩，切开复位时平均年龄为10岁（范围4岁至15岁11个月）。每位患者均接受了桡骨头切开复位，联合尺骨后弯延长截骨及环状韧带重建。平均随访7年，回顾临床及影像学疗效。
随访时术后梅奥肘关节功能指数范围为65至100，其中19例为优，2例为良，1例为可，无差的结果。最新随访时，17例患者桡骨头保持完全复位，5例患者桡骨头半脱位。4例患者在肱桡关节观察到骨关节炎改变。影像学方面，15例为好，7例为可，无差的结果。受伤后3年内或12岁前接受切开复位的所有患者均获得了良好的影像学结果，而其余8例患者中有7例获得了可的结果。
如果在患者年龄小于12岁或受伤后3年内对漏诊的孟氏骨折进行切开复位，可预期获得良好的长期临床及影像学疗效。
