Department of Orthopedics, The First Affiliated Hospital of Guangxi Medical University, 6 Shuangyong Road, Nanning, Guangxi, China.
Research Centre for Regenerative Medicine, Guangxi Key Laboratory of Regenerative Medicine, Guangxi Medical University, 22 Shuangyong Road, Nanning, Guangxi, China.
Sci Rep. 2022 Jun 17;12(1):10238. doi: 10.1038/s41598-022-14513-2.
The present study aimed to explore the influence of ulnar bow on the surgical treatment of Bado type I missed Monteggia fracture in children. A retrospective review of 28 patients was conducted between November 2010 and June 2020. All patients were treated with open reduction of the radial head and ulnar opening wedge osteotomy without annular ligament reconstruction. Four months (range 1-12 months) was the mean interval between injury onset and surgery. The average age of patients at the time of surgery was 6.1 years old (range 2-10 years old). The maximum ulnar bow (MUB) and MUB position (P-MUB) via radiography were evaluated. The patients were divided into two groups according to P-MUB, as follows: middle group (A) included 17 cases, and the MUB was located at 40-60% of the distal ulna; and distal group (B) included 11 cases, and the MUB was located at 20-40% from the distal end of the ulna. The mean follow-up period was 33 months (range 6-102 months). At the last follow-up, all the children showed stable reduction of the radial head, and the flexion function of elbow joint improved after the operation (P < 0.05). Group A presented a larger ratio of maximum ulnar bow (R-MUB) and angle of ulnar osteotomy (OA) than group B (P < 0.05). The osteotomy angle was positively correlated with the R-MUB (R = 0.394, P = 0.038). The osteotomy angle was positively correlated with the P-MUB (R = 0.683, P = 0.000). The R-MUB was proportional to the P-MUB (R = 0.459, P < 0.0001). The regression equation of P-MUB and osteotomy angle was as follows: OA = 32.64* P-MUB + 7.206. If the ulnar bow was positioned at the middle ulna, then a stable reduction of radial head needed to be achieved through a large angle in the ulnar osteotomy. If the position of maximum ulnar bow (P-MUB) was closer to the middle of the ulna, or the ratio of maximum ulnar bow (R-MUB) was larger, then the osteotomy angle was larger.
本研究旨在探讨尺骨弓对儿童 Bado Ⅰ型孟氏骨折手术治疗的影响。回顾性分析 2010 年 11 月至 2020 年 6 月间收治的 28 例患者。所有患者均采用切开复位桡骨头，尺骨开楔形截骨术，不重建环状韧带。损伤至手术的平均时间为 4 个月（1-12 个月）。患者手术时的平均年龄为 6.1 岁（2-10 岁）。通过 X 线评估最大尺骨弓（MUB）和最大尺骨弓位置（P-MUB）。根据 P-MUB 将患者分为两组：中间组（A 组）17 例，MUB 位于尺骨远端 40-60%；远端组（B 组）11 例，MUB 位于尺骨远端 20-40%。平均随访时间为 33 个月（6-102 个月）。末次随访时，所有患儿桡骨头复位稳定，肘关节屈伸功能均较术前改善（P<0.05）。A 组的最大尺骨弓比率（R-MUB）和尺骨截骨角度（OA）均大于 B 组（P<0.05）。截骨角度与 R-MUB 呈正相关（R=0.394，P=0.038）。截骨角度与 P-MUB 呈正相关（R=0.683，P=0.000）。R-MUB 与 P-MUB 呈比例关系（R=0.459，P<0.0001）。P-MUB 和截骨角度的回归方程为：OA=32.64*P-MUB+7.206。如果尺骨弓位于尺骨中段，则需要通过较大的尺骨截骨角度实现桡骨头的稳定复位。如果最大尺骨弓位置（P-MUB）更靠近尺骨中段，或者最大尺骨弓比率（R-MUB）更大，则截骨角度更大。
