Department of Orthopedics, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, 200233 Shanghai, China.
Jt Dis Relat Surg. 2022;33(2):285-293. doi: 10.52312/jdrs.2022.662. Epub 2022 Jul 6.
This study aims to evaluate the efficacy of close-wedge osteotomy and monorail external fixator in the treatment of chronic Monteggia fracture.
Between January 2014 and December 2021, data of a total of 22 patients (14 males, 8 females; mean age: 15.6±5.1 years; range, 6 to 25 years) who suffered from chronic Monteggia fractures were retrospectively reviewed. All the patients were treated for acute angulation of the ulna after osteotomy and gradual angulation for radial head reduction. Range of motion of the elbow and forearm, the angle between the longitudinal axis of proximal radius and the hypothesized Storen's line (RSA), Visual Analog Scale (VAS), and Mayo Elbow Performance Score (MEPS), as well as Disabilities of Arm, Shoulder and Hand (DASH) score were recorded preoperatively and at the final follow-up.
Objective parameters were all significantly improved in the aspects of range of motions of the elbow and forearm, and RSA (21.4±4.5° preoperatively and 2.0±1.4° at the final follow-up, t=18.20, p<0.05). The level of pain due to the chronic injury was eliminated, as the mean VAS was significantly lower at the final follow-up compared to preoperative scoring (2.8±2.0 preoperatively and 0.5±0.9 at the final follow-up, t=4.86, p<0.05). The function of the elbow and upper limb was restored, which was indicated by improved MEPS (73.2±12.5 preoperatively and 96.6±6.4 at the final follow-up, t=7.70, p<0.05) and DASH (28.3±6.0 preoperatively and 4.1±2.0 at the final follow-up, t=19.35, p<0.05). No complication was observed.
Close-wedge osteotomy and gradual lengthening with monorail external fixator in the treatment of chronic Monteggia fracture showed great efficacy. We also provided a specified osteotomy site aiming at PRUJ reconstruction.
本研究旨在评估闭合楔形截骨术和单轨外固定器治疗慢性孟氏骨折的疗效。
回顾性分析 2014 年 1 月至 2021 年 12 月期间收治的 22 例（男 14 例，女 8 例；平均年龄 15.6±5.1 岁；年龄 6~25 岁）慢性孟氏骨折患者的临床资料。所有患者均采用截骨术后尺骨近段成角、桡骨头逐渐成角复位治疗急性成角。记录术前和末次随访时的肘部和前臂活动度、桡骨近端长轴与假设的 Storen 线（RSA）之间的夹角、视觉模拟评分（VAS）、Mayo 肘功能评分（MEPS）以及上肢残疾问卷（DASH）评分。
在肘部和前臂活动度以及 RSA 方面，所有客观参数均明显改善（术前 21.4±4.5°，末次随访时 2.0±1.4°，t=18.20，p<0.05）。慢性损伤引起的疼痛程度消除，末次随访时 VAS 评分明显低于术前（术前 2.8±2.0，末次随访时 0.5±0.9，t=4.86，p<0.05）。MEPS（术前 73.2±12.5，末次随访时 96.6±6.4，t=7.70，p<0.05）和 DASH（术前 28.3±6.0，末次随访时 4.1±2.0，t=19.35，p<0.05）评分改善，提示肘部和上肢功能恢复。无并发症发生。
闭合楔形截骨术和单轨外固定器逐渐延长治疗慢性孟氏骨折疗效确切。我们还提供了一个特定的截骨部位，旨在重建 PRUJ。
