Department of Pediatric Orthopedics, Xin Hua Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Yangpu District, 1665 Kongjiang Road, Shanghai, China.
Department of Pediatric Orthopedics, National Children's Medical Center & Children's Hospital of Fudan University, 379 Wanyuan Road, Minhang District, Shanghai, China.
Int Orthop. 2022 Oct;46(10):2299-2306. doi: 10.1007/s00264-022-05473-3. Epub 2022 Jun 14.
Monteggia fracture-dislocation refers to traumatic ulnar fractures and dislocation of the radial head, which is one of the most frequently missed injuries, especially in children. The most widespread attitude towards chronic Monteggia lesion is the open reduction of the radial head associated with ulnar osteotomy with or without annular ligament reconstruction. Our study aimed to analyze the risk factors for redislocation after surgical management of chronic Monteggia lesion and the benefits of annular ligament reconstruction and radiocapitellar pinning in paediatric.
We retrospectively reviewed patients treated with reconstruction surgery for chronic Monteggia fracture-dislocation in our department between 2005 and 2017, with a minimum two years' follow-up. The reconstruction surgery included ulnar osteotomy performed in all patients, annular ligament repair or reconstruction or fixation of radiocapitellar joint, or radial osteotomy in some patients. We collected the related clinical data and evaluated the risk factors of redislocation using logistic regression analyses and a two-piecewise linear regression model with a smoothing function, after reconstruction.
Throughout a mean six years' follow-up (range, 2-14 years), 62 patients (42 males, 20 females; average age 6.49 years range, 2-13 years) were reviewed. Of the radiocapitellar joints, 16.1% was noted to have redislocation. Univariate risk analysis showed age, time from injury to surgery, and radial osteotomy were risk factors for a recurrent radiocapitellar redislocation. Time from injury to surgery was found to be independent predictor of redislocation in multivariate analysis. However, there were significant nonlinear associations between time from injury to surgery and redislocation in multivariate logistic regression analysis after multivariate adjustment (p for nonlinear = 0.023). Every one month increase was associated with a 1.37-fold increase in redislocation, in participants within one year after injury.
In conclusion, the surgery of chronic Monteggia fracture-dislocation should be done as quickly as possible within one year after injury. Associated annular ligament reconstruction or fixation of radiocapitellar joint does not seem to be helpful.
孟氏骨折脱位是指创伤性尺骨骨折和桡骨头脱位，这是最常被漏诊的损伤之一，尤其是在儿童中。对于慢性孟氏损伤，最广泛的治疗态度是切开复位桡骨头，并联合尺骨截骨术，或联合或不联合环状韧带重建。我们的研究旨在分析儿童慢性孟氏损伤手术治疗后再脱位的危险因素，以及环状韧带重建和桡骨头骨钉固定的作用。
我们回顾性分析了 2005 年至 2017 年期间在我科接受慢性孟氏骨折脱位重建手术治疗的患者，随访时间至少 2 年。重建手术包括所有患者的尺骨截骨术、环状韧带修复或重建或桡骨头关节固定术，或部分患者的桡骨截骨术。我们收集了相关的临床资料，并使用逻辑回归分析和带有平滑函数的两段线性回归模型，对重建后再脱位的危险因素进行了评估。
在平均 6 年的随访期内（范围 2-14 岁），共 62 例患者（男 42 例，女 20 例；平均年龄 6.49 岁，范围 2-13 岁）接受了回顾性分析。16.1%的患者出现桡骨头再脱位。单因素风险分析显示，年龄、受伤至手术时间和桡骨截骨术是桡骨头再脱位的危险因素。多因素分析显示，受伤至手术时间是再脱位的独立预测因素。然而，在多因素调整后的多变量逻辑回归分析中，受伤至手术时间与再脱位之间存在显著的非线性关系（p 非线性=0.023）。在受伤后 1 年内，每增加 1 个月，再脱位的风险增加 1.37 倍。
总之，慢性孟氏骨折脱位的手术应在受伤后 1 年内尽快进行。联合环状韧带重建或桡骨头关节固定术似乎没有帮助。
