Eamsobhana Perajit, Kaewpornsawan Kamolporn
Department of Orthopaedic Surgery, Faculty of Medicine, Siriraj Hospital, Bangkok, Thailand.
J Med Assoc Thai. 2012 Sep;95 Suppl 9:S47-53.
The purpose of the present study is to evaluate the clinical and radiographic outcomes after open reduction and Z-lengthening technique with annular ligament reconstruction for the treatment of a chronic Monteggia fracture-dislocation.
The authors postoperatively investigated the clinical and radiographic outcomes for ten children with a chronic Monteggia fracture. The present study group included seven boys and three girls mean age of nine years and one month at the time of open reduction. Each patient had been treated with open reduction of the radial head combined with ulna osteotomy and elongation, bending with z-plasty technique and annular ligament reconstruction. Clinical and radiographic outcomes were reviewed over a mean duration of follow-up of thirty-eight months.
The postoperative Mayo Elbow Performance Index (MEPI) at the time of follow-up ranged from 95 to 100 and no poor results. The radial head remained in a completely reduced position in ten patients. In three patients, osteoarthritic changes were observed at the radiohumeral joint. Radiographically, there were seven good, three fair and no poor results. A fair radiographic result was obtained in the patients who had undergone open reduction more than three years after the injury and two patients was operation at the age of eleven and thirteen years old.
Good clinical and radiographic outcomes can be expected if open reduction for the treatment of a chronic Monteggia fracture is performed when the patient is less than twelve years of age or within three years after the injury. Open reduction and Z-lengthening technique with annular ligament reconstruction for the treatment of a chronic Monteggia fracture-dislocation is safe with good clinical and radiologic outcomes without the need for bone graft. No nonunion is report in our series.
本研究旨在评估切开复位联合Z形延长技术并重建环状韧带治疗陈旧性孟氏骨折脱位的临床和影像学效果。
作者对10例陈旧性孟氏骨折患儿的临床和影像学结果进行了术后调查。本研究组包括7名男孩和3名女孩，切开复位时平均年龄为9岁1个月。每位患者均接受了桡骨头切开复位联合尺骨截骨延长、Z形成形术及环状韧带重建治疗。对患者进行了平均38个月的随访，回顾其临床和影像学结果。
随访时术后梅奥肘关节功能指数（MEPI）范围为95至100，无不良结果。10例患者的桡骨头均保持完全复位。3例患者在肱桡关节观察到骨关节炎改变。影像学检查结果为7例优、3例良，无差的结果。受伤后三年以上接受切开复位的患者以及11岁和13岁接受手术的2例患者获得了良好的影像学结果。
如果在患者年龄小于12岁或受伤后三年内进行切开复位治疗陈旧性孟氏骨折，可预期获得良好的临床和影像学效果。切开复位联合Z形延长技术并重建环状韧带治疗陈旧性孟氏骨折脱位是安全的，具有良好的临床和影像学效果，无需植骨。我们的系列研究中未报告骨不连情况。
