Wei Shizhan, Tang Yujin, Ban Huadeng
Zhongguo Xiu Fu Chong Jian Wai Ke Za Zhi. 2016 Jan;30(1):50-3.
To investigate the effectiveness of a modified surgical treatment of old Monteggia fracture.
Between March 2006 and December 2013, 40 cases of old Monteggia fracture were treated with modified operation. Modified operation procedure included expanding excision of pedicled forearm fascia flap for reconstruction of the annular ligament and repair of elbow radial lateral collateral ligament complex and extending osteotomy of the ulna, callus replantation, and internal fixation with steel plate. There were 26 boys and 14 girls, aged 2-10 years with an average age of 4 years. Injury was caused by falling in 24 cases, by traffic accident in 8 cases, and by falling from height in 8 cases. The disease duration was 2-11 months (mean, 4 months). Four patients had combined radial nerve palsy.
Incision healed by first intention after operation, without early complication of radial nerve palsy, fascial compartment syndrome, or decreased hand extensor muscle strength. All the children were followed up 1-5 years (mean, 2.5 years). X-ray films showed fracture healing, and the healing time was 10-20 weeks (mean, 15 weeks). During follow-up, 3 cases had re-dislocation. Neither hand dysfunction caused by hand muscle adhesion nor radial head bottleneck shape change was found. On the basis of the functional evaluation criteria by Mackay, the results were excellent in 32 cases, good in 5 cases, and poor in 3 cases; the excellent and good rate was 92.5% at last follow-up.
The modified surgical treatment of old Monteggia fracture is an effective method, with good matching of humeroradial joint and without internal fixation of the humeroradial joint.
探讨改良手术治疗陈旧性孟氏骨折的疗效。
2006年3月至2013年12月，对40例陈旧性孟氏骨折患者采用改良手术治疗。改良手术步骤包括带蒂前臂筋膜瓣扩大切除重建环状韧带、修复肘外侧副韧带复合体、尺骨延长截骨、骨痂回植及钢板内固定。其中男26例，女14例，年龄2～10岁，平均4岁。致伤原因：跌倒24例，交通事故8例，高处坠落8例。病程2～11个月（平均4个月）。4例合并桡神经麻痹。
术后切口一期愈合，无桡神经麻痹、筋膜间室综合征或手部伸肌肌力下降等早期并发症。所有患儿均获随访1～5年（平均2.5年）。X线片显示骨折愈合，愈合时间为10～20周（平均15周）。随访期间，3例出现再脱位。未发现因手部肌肉粘连导致的手部功能障碍及桡骨头瓶颈状改变。根据Mackay功能评价标准，结果优32例，良5例，差3例；末次随访时优良率为92.5%。
改良手术治疗陈旧性孟氏骨折是一种有效的方法，肱桡关节匹配良好，无需对肱桡关节进行内固定。
