Li Hai, Cai Qi-Xun, Shen Pin-Quan, Chen Ting, Zhang Zi-Ming, Zhao Li
Department of Pediatric Orthopaedics, Xin-Hua Hospital, Shanghai Jiaotong University School of Medicine, Shanghai 200092, China.
Chin J Traumatol. 2013;16(3):131-5.
Although most of nerve injuries associated with Monteggia fracture-dislocation in children are neurapraxias and will recover spontaneously after conservative treatment, surgical exploration of the involved nerve is always required in the cases with the entrapment of posterior interosseous nerve (PIN). However, the necessity and time frame for surgical intervention for specific patterns of nerve dysfunction remains controversial. The aim of the report is to observe and understand the pathology of PIN injury associated with Monteggia fracture-dislocation in children, and to propose the possible indication for the exploration of nerve.
Eight cases, six boys and two girls, with Monteggia fracture-dislocation complicated by PIN injury, managed operatively at the authors?Hospital from 2007 to 2008 were retrospectively reviewed. All the patients underwent the attempted closed reduction before they received exploration of PIN, with open reduction and internal fixation or successful closed reduction.
The PIN was found to be trapped acutely posterior to the radiocapitellar joint in 4 out of 5 Type III Bado's Monteggia fractures. In the remaining cases, since there were longer time intervals from injury to operation, chronic compressive changes and epineural fibrosis of radial nerve were visualized. After a microsurgical neurolysis performed, the complete recovery in the nerve function was obtained in all the cases during the follow-up.
The findings from this study suggest that every case of type III Monteggia fracture-dislocation with decreased or absent function of muscles innervated by PIN and an irreducible radial head in children should be viewed as an indication for immediate surgical exploration of the involved nerve to exclude a potential PIN entrapment.
尽管儿童孟氏骨折脱位相关的神经损伤大多为神经失用症，保守治疗后可自发恢复，但对于骨间后神经（PIN）卡压的病例，总是需要对受累神经进行手术探查。然而，针对特定神经功能障碍模式进行手术干预的必要性和时间框架仍存在争议。本报告旨在观察和了解儿童孟氏骨折脱位相关的PIN损伤的病理情况，并提出神经探查的可能指征。
回顾性分析2007年至2008年在作者所在医院接受手术治疗的8例孟氏骨折脱位合并PIN损伤的病例资料，其中男6例，女2例。所有患者在接受PIN探查前均尝试进行了闭合复位，随后进行切开复位内固定或成功的闭合复位。
在5例III型巴多孟氏骨折中，有4例发现PIN急性卡压于桡骨头关节后方。在其余病例中，由于受伤至手术间隔时间较长，可以看到桡神经存在慢性受压改变和神经外膜纤维化。在进行显微神经松解术后，所有病例在随访期间神经功能均完全恢复。
本研究结果表明，对于儿童III型孟氏骨折脱位伴PIN支配肌肉功能减退或丧失且桡骨头无法复位的每一例病例，均应视为立即对受累神经进行手术探查以排除潜在PIN卡压的指征。
