Cao Yin-Qiang, Deng Jia-Zhong, Zhang Yuan, Yuan Xiao-Wei, Liu Tao, Li Jun, Li Xiang, Gou Pan, Li Ming, Liu Xing
Department of Orthopedics, Ministry of Education Key Laboratory of Child Development and Disorders, National Clinical Research Center for Child Health and Disorders, China International Science and Technology Cooperation Base of Child Development and Critical Disorders, Chongqing Key Laboratory of Pediatrics, Children's Hospital of Chongqing Medical University, Chongqing, China.
Cangxi Social Insurance Hospital, Guangyuan City, Sichuan Province, China.
Chin J Traumatol. 2020 Aug;23(4):233-237. doi: 10.1016/j.cjtee.2020.05.004. Epub 2020 May 22.
To evaluate the efficacy of closed reduction on the humeroradial joint in the treatment of Bado type Ⅰ, Ⅱ and Ⅲ fresh Monteggia fractures in children and investigate the effect of clinical factors, including Bado classification, age and time of treatment on the success rate of closed reduction.
We retrospectively studied the data of children ≤10 years old with fresh Monteggia fractures (injury within two weeks) treated by manual reduction with plaster immobilization from January 2014 to April 2019. All patients were followed up in the outpatient department every two weeks for 4-6 weeks until plaster removal and then 3, 6 and 12 months. Online or telephone interview was provided for some inconvenient patients after 6 months. Mackay criteria were used to evaluate the clinical effect. Radiographic data were collected and reviewed to assess the reduction of the humeroradial joint. Function of the elbow joint and forearm was evaluated and risk factors related to the failure of reduction were assessed. The successful manual reduction was analyzed from three aspects, respectively Bado fracture type (Ⅰ, Ⅱ, Ⅲ), patient age (<3 year, 3-6 years, >6 years) and time interval from injury to treatment (group A, <1 day; group B, 1-3 days; group C, >3 days).
Altogether 88 patients were employed in this study, including 58 males (65.9%) and 30 females (34.1%) aged from 1 to 10 years. There were 29 cases (33.0%) of Bado type Ⅰ Monteggia fractures, 16 (18.2%) type Ⅱ and 43 (48.7%) type Ⅲ. Successful manual reduction was achieved in 79 children (89.8%) at the last follow-up. The failed 9 patients received open surgery. Mackay criteria showed 100% good-excellent rate for all the patients. The success rate of manual reduction was 89.7%, 87.5% and 90.7% in Bado type Ⅰ, Ⅱ and Ⅲ cases, respectively, revealing no significant differences among different Bado types (χ = 0.131, p = 0.937). Successful closed reduction was achieved in 13 toddlers (13/13, 100%), 38 preschool children (28/42, 90.5%) and 28 school-age children (28/33, 84.8%), suggesting no significant difference either (χ = 2.375, p = 0.305). However time interval from injury to treatment showed that patients treated within 3 days had a much higher rate of successful manual reduction: 67 cases (67/71, 94.4%) in group A, 10 cases (10/11, 90.9%) in group B, and 2 cases (2/6, 33.3%) in group C (χ = 22.464, p < 0.001). Fisher's test further showed significant differences between groups A and C (p = 0.001) and groups B and C (p = 0.028).
Closed reduction is a safe and effective method for treating fresh Monteggia fractures in children. The reduction should be conducted as soon as possible once the diagnosis has been made.
评估闭合复位治疗儿童BadoⅠ型、Ⅱ型和Ⅲ型新鲜孟氏骨折时对肱桡关节的疗效，并探讨包括Bado分型、年龄和治疗时间等临床因素对闭合复位成功率的影响。
回顾性研究2014年1月至2019年4月采用手法复位加石膏固定治疗的10岁及以下新鲜孟氏骨折（伤后两周内）患儿的数据。所有患者每两周在门诊随访4至6周直至拆除石膏，之后分别在3个月、6个月和12个月进行随访。对部分不方便前来的患者在6个月后进行在线或电话随访。采用Mackay标准评估临床疗效。收集并复查影像学数据以评估肱桡关节的复位情况。评估肘关节和前臂的功能以及与复位失败相关的危险因素。分别从Bado骨折类型（Ⅰ型、Ⅱ型、Ⅲ型）、患者年龄（<3岁、3至6岁、>6岁）和伤后至治疗的时间间隔（A组，<1天；B组，1至3天；C组，>3天）三个方面分析手法复位成功情况。
本研究共纳入88例患者，其中男性58例（65.9%），女性30例（34.1%），年龄1至10岁。BadoⅠ型孟氏骨折29例（33.0%），Ⅱ型16例（18.2%），Ⅲ型43例（48.7%）。末次随访时79例患儿（89.8%）手法复位成功。9例复位失败患者接受了切开手术。Mackay标准显示所有患者的优良率为100%。BadoⅠ型、Ⅱ型和Ⅲ型病例的手法复位成功率分别为89.7%、87.5%和90.7%，不同Bado类型之间无显著差异（χ² = 0.131，p = 0.937）。13例幼儿（13/13，100%）、38例学龄前儿童（28/42，90.5%）和28例学龄儿童（28/33，84.8%）闭合复位成功，差异也无统计学意义（χ² = 2.375，p = 0.305）。然而伤后至治疗的时间间隔显示，伤后3天内接受治疗的患者手法复位成功率更高：A组67例（67/71，94.4%），B组10例（10/11，90.9%），C组2例（2/6，33.3%）（χ² = 22.464，p < 0.001）。Fisher检验进一步显示A组与C组（p = 0.001）以及B组与C组（ p = 0.028）之间存在显著差异。
闭合复位是治疗儿童新鲜孟氏骨折的一种安全有效的方法。一旦确诊应尽早进行复位。
