Ring D, Jupiter J B, Waters P M
Harvard Combined Orthopaedic Residency, Massachusetts General Hospital, Boston, MA, USA.
J Am Acad Orthop Surg. 1998 Jul-Aug;6(4):215-24. doi: 10.5435/00124635-199807000-00003.
The eponymous term "Monteggia fracture" is most precisely used to refer to dislocation of the proximal radioulnar joint in association with a forearm fracture. It is the character of the ulnar fracture, rather than the direction of radial head dislocation, that is useful in determining the optimal treatment of Monteggia fractures in both children and adults. Stable anatomic reduction of the ulnar fracture results in anatomic reduction of the radial head. The notoriously poor results of treatment of Monteggia fractures in adults improved dramatically after the development of modern techniques of plate-and-screw fixation, which facilitate early mobilization by ensuring anatomic reduction. The relatively good results associated with nonoperative treatment of pediatric Monteggia injuries reflect the prevalence of stable (incomplete) fractures in children. Unstable (complete) ulnar fractures are prone to residual or recurrent displacement and may require operative fixation. Late reconstruction of chronic Monteggia lesions in children can be complicated and unpredictable. The key to a good outcome after a Monteggia-type fracture-dislocation of the forearm remains early recognition of proximal radioulnar dissociation.
以人名命名的“孟氏骨折”最确切的含义是指尺桡近端关节脱位合并前臂骨折。在确定儿童和成人孟氏骨折的最佳治疗方法时，尺骨骨折的特点比桡骨头脱位的方向更具指导意义。尺骨骨折的稳定解剖复位可使桡骨头解剖复位。现代钢板螺钉固定技术出现后，成人孟氏骨折治疗效果差的情况得到了显著改善，该技术通过确保解剖复位促进了早期活动。小儿孟氏损伤非手术治疗效果相对较好，这反映了儿童稳定（不完全）骨折的发生率较高。不稳定（完全）尺骨骨折容易残留或反复移位，可能需要手术固定。儿童慢性孟氏损伤的晚期重建可能复杂且难以预测。前臂孟氏型骨折脱位后获得良好预后的关键在于早期识别尺桡近端分离。
