Department of Orthopaedic Surgery, Boston Children's Hospital, Boston, MA.
J Pediatr Orthop. 2020 Nov/Dec;40(10):e916-e921. doi: 10.1097/BPO.0000000000001630.
Chronic Monteggia lesions in children may cause pain, deformity, decreased range of motion, and neurological symptoms. Numerous surgical techniques have been advocated to reconstruct long-standing Monteggia injures in efforts to maximize long-term upper limb function. The purpose of this investigation was to assess the clinical and radiographic results of a modified surgical technique for missed Monteggia fracture-dislocations.
A retrospective evaluation of 52 patients who underwent surgical reconstruction of missed Monteggia fracture-dislocations at a tertiary pediatric hospital was performed. The median patient age at the time of surgery was 6.8 years, and the median time from injury to surgery was 12.9 weeks. Electronic medical records, including clinic notes, radiographic images, and operative reports, were reviewed for study analysis. Median clinical and radiographic follow-up was 19.1 months.
The median elbow range of motion improved from 108 degrees of flexion and 5 degrees short of full extension preoperatively to 140 degrees of flexion (P<0.001) and full extension (P=0.10) postoperatively. Forearm range of motion also improved from a median of 80 degrees of pronation and 58 degrees of supination preoperatively to 80 degrees of pronation (P=0.54) and 80 degrees of supination (P<0.001) postoperatively. Congruent radiocapitellar alignment was maintained in 39 patients (75%). Nine patients (17%) had redislocation of the radiocapitellar joint, and 4 patients (8%) had radiographic resubluxation. Six of the 9 patients who experienced redislocation underwent early revision and achieved uncomplicated longer term results. Patients who received repair of the native annular ligament were more likely to achieve lasting radiocapitellar joint stability (P=0.03) when compared with patients who received annular ligament reconstruction or if the annular ligament was not addressed.
Meaningful improvements in elbow motion and radiocapitellar stability can be safely achieved in the majority of children following surgical reconstruction of missed Monteggia lesions.
Level IV-retrospective case series.
儿童慢性孟氏骨折可能导致疼痛、畸形、活动范围减小和神经症状。为了最大限度地提高上肢功能的长期效果，已经提出了许多手术技术来重建陈旧性孟氏损伤。本研究的目的是评估一种改良手术技术治疗陈旧性孟氏骨折脱位的临床和影像学结果。
对一家三级儿科医院对 52 例陈旧性孟氏骨折脱位患者进行手术重建的患者进行回顾性评估。手术时患者的中位年龄为 6.8 岁，从受伤到手术的中位时间为 12.9 周。电子病历包括临床记录、影像学图像和手术报告，用于研究分析。中位数临床和影像学随访时间为 19.1 个月。
中位数的肘部活动范围从术前的 108 度屈曲和 5 度伸直至术后的 140 度屈曲（P<0.001）和完全伸展（P=0.10）得到改善。前臂活动范围也从术前的 80 度旋前和 58 度旋后改善至术后的 80 度旋前（P=0.54）和 80 度旋后（P<0.001）。39 例（75%）患者保持桡骨小头关节对线一致。9 例（17%）患者发生桡骨小头关节再脱位，4 例（8%）患者发生影像学复发性半脱位。9 例再脱位患者中有 6 例接受早期翻修，取得了无并发症的长期结果。与接受环状韧带重建或未处理环状韧带的患者相比，接受环状韧带修复的患者更有可能获得持久的桡骨小头关节稳定性（P=0.03）。
在大多数儿童中，手术重建陈旧性孟氏骨折脱位后，肘部运动和桡骨小头稳定性都可以得到显著改善。
IV 级-回顾性病例系列。
