Baydar Mehmet, Öztürk Kahraman, Orman Osman, Akbulut Deniz, Keskinbıçkı Mehmet Vakıf, Şencan Ayşe
Baltalimani Bone Diseases Research Hospital Hand Surgery Clinic, University of Health Science Turkey Medical School, İstanbul.
Baltalimani Bone Diseases Research Hospital Hand Surgery Clinic, University of Health Science Turkey Medical School, İstanbul.
J Hand Surg Am. 2022 May;47(5):481.e1-481.e9. doi: 10.1016/j.jhsa.2021.05.025. Epub 2021 Jul 10.
Opening-wedge osteotomy of the ulna restores normal ulnar length and corrects the angulation of the ulna in patients with chronic Monteggia fracture-dislocations. In addition, this eases the reduction of the radial head. Morbidity caused by annular ligament reconstruction surgery can be prevented by preserving the intact annular ligament. After dilatation and mobilization of the annular ligament, reduction of the radial head can be accomplished. This study evaluated the effectiveness of corrective opening-wedge ulnar osteotomy and radial head relocation into the intact annular ligament in the treatment of radiocapitellar instability secondary to pediatric chronic Monteggia fracture-dislocation.
Fourteen patients diagnosed with radial head dislocation associated with plastic deformation of the ulna or ulnar fracture were included in the study. Radiologic and clinical results of these patients who underwent corrective ulnar osteotomy and radial head relocation into an intact annular ligament were evaluated retrospectively.
The mean age of the patients at the time of injury was 7.4 years (range, 3 years to 12 years). The average time between the injury and surgery was 19.1 months (median, 8 months; range, 3 months to 66 months); the average follow-up period was 28.7 months (range, 12 months to 60 months). The mean Kim score was 69.6 (range, 50 to 75) preoperatively and 92.9 (60 to 100) at last follow-up. According to Kim score, the results were considered excellent in 12 cases and poor in 2 cases. Radial head subluxation recurred in 2 separate cases. In addition, chondrolysis changes were seen in 1 case. Reduction loss and osteoarthritic changes in the radiocapitellar joint were considered poor results in follow-up radiographs.
Corrective ulnar osteotomy and relocating the radial head into the intact annular ligament can be safely used for treating chronic Monteggia fracture-dislocation cases without radial head and capitellum deformity.
TYPE OF STUDY/LEVEL OF EVIDENCE: Therapeutic IV.
尺骨开放楔形截骨术可恢复慢性孟氏骨折脱位患者的正常尺骨长度并纠正尺骨成角。此外，这有助于桡骨头复位。通过保留完整的环状韧带可预防环状韧带重建手术引起的并发症。在环状韧带扩张和活动后，桡骨头可实现复位。本研究评估了矫正性开放楔形尺骨截骨术及将桡骨头重新置于完整环状韧带内治疗小儿慢性孟氏骨折脱位继发桡肱关节不稳的有效性。
本研究纳入了14例诊断为桡骨头脱位合并尺骨塑性变形或尺骨骨折的患者。对这些接受了矫正性尺骨截骨术及将桡骨头重新置于完整环状韧带内的患者的影像学和临床结果进行回顾性评估。
患者受伤时的平均年龄为7.4岁（范围3岁至12岁）。受伤至手术的平均时间为19.1个月（中位数8个月；范围3个月至66个月）；平均随访期为28.7个月（范围12个月至60个月）。术前平均Kim评分为69.6（范围50至75），末次随访时为92.9（60至100）。根据Kim评分，结果12例为优，2例为差。2例出现桡骨头半脱位复发。此外，1例出现了软骨溶解改变。随访X线片显示桡肱关节复位丢失和骨关节炎改变被认为是不良结果。
矫正性尺骨截骨术及将桡骨头重新置于完整环状韧带内可安全用于治疗无桡骨头和肱骨小头畸形的慢性孟氏骨折脱位病例。
研究类型/证据水平：治疗性IV级。
