兒童類孟氏骨折的分型與治療_《中國修復重建外科雜志》

作者：

于鐵強 , 左玉明 , 王月光 , 周宏艷 , 王國強 , 易凡 , 張磊 , 王晶 , 邢愛春 , 馬建鳳

唐山市第二醫院小兒骨科（河北唐山，063000）;

關鍵詞：

類孟氏骨折骨折分型標準內固定兒童

DOI：

10.7507/1002-1892.20130286

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目的探討兒童類孟氏骨折的分型標準及手術治療方法和療效。方法回顧性分析2008年1月－2012年1月收治的35例類孟氏骨折患兒臨床資料。男17例，女18例；年齡1歲2個月～14歲11個月，平均7歲5個月。致傷原因：跌傷25例，摔傷3例，運動傷7例。受傷至入院時間1 h～16 d，中位時間28 h。根據自定義骨折分型標準：Ⅰ型為尺骨骨折（包括鷹嘴）伴橈骨頸骨折或橈骨近端骨骺損傷，22例；Ⅱ型為肘關節后脫位伴橈骨頸骨折或橈骨近端骨骺損傷，2例；Ⅲ型為尺骨和/或鷹嘴骨折伴肱骨外髁骨折，10例；Ⅳ型為尺、橈骨骨折伴橈骨頸骨折或橈骨近端骨骺損傷，1例。根據分型結果，對骨折復位后行內固定或輔助石膏外固定。結果術后患兒切口均Ⅰ期愈合，無切口感染等并發癥發生。34例患兒獲隨訪，隨訪時間12～18個月，平均14個月。X線片復查示，骨折均愈合，骨折愈合時間6周～5 個月，平均2.5個月。末次隨訪時，采用改良肘關節美國特種外科醫院（HSS）評分評價療效，獲優29例，良4例，可2例，優良率達94%。無肘內、外翻及遲發性尺神經炎等并發癥發生。結論與傳統分型標準相比，自定義分型標準簡單易記，有利于減少漏診率及選擇治療方法；手術是治療兒童類孟氏骨折的有效方法。

引用本文： 于鐵強,左玉明,王月光,周宏艷,王國強,易凡,張磊,王晶,邢愛春,馬建鳳. 兒童類孟氏骨折的分型與治療. 中國修復重建外科雜志, 2013, 27(11): 1309-1312. doi: 10.7507/1002-1892.20130286 復制

1.	Bado JL. The Monteggia lesion. Clin Orthop Relat Res, 1967, (50): 71-86.
2.	Jamses HB, James RK. Fractures in Children. 7th ed. Philadelphia: Lippincott Williams&Wilkins, 2010: 446-450.
3.	Sferopoulos NK. Monteggia type IV equivalent injury. Open Orthop J, 2011, 5: 198-200.
4.	Güven M, Eren A, Kadio?lu B, et al. The results of treatment in pediatric Monteggia equivalent lesions. Acta Orthop Traumatol Turc, 2008, 42(2): 90-96.
5.	Ravessoud FA. Lateral condylar fracture and ipsilateral ulnar shaft fracture: Monteggia equivalent lesions? J Pediatr Orthop, 1985, 5(3): 364-366.
6.	Arora S, Sabat D, Verma A, et al. An unusual monteggia equivalent: a case report with literature review. J Hand Microsurg, 2011, 3(2): 82-85.
7.	Sood A, Khan O, Bagga T. Simultaneous monteggia type I fracture equivalent with ipsilateral fracture of the distal radius and ulna in a child: a case report. J Med Case Reports, 2008, 2: 190.
8.	Gaston MS, Irwin GJ, Huntley JS. Lateral condyle fracture of a child’s humerus: the radiographic features may be subtle. Scott Med J, 2012, 57(3): 182.
9.	Fowles JV, Kassab MT. Observations concerning radial neck fractures in children. J Pediatr Orthop, 1986, 6(1): 51-57.
10.	Klitscher D, Richter S, Bodenschatz K, et al. Evaluation of severely displaced radial neck fractures in children treated with elastic stable intramedullary nailing. J Pediatr Orthop, 2009, 29(7): 698-703.
11.	Toh S, Tsubo K, Nishikawa S, et al. Long-standing nonunion of fractures of the lateral humeral condyle. J Bone Joint Surg (Am), 2002, 84-A(4): 593-598.
12.	張立軍, 吉士俊. 重視肱骨外髁骨折的規范化治療. 中國矯形外科雜志, 2012, 20(18): 1633-1637.
13.	Thomas DP, Howard AW, Cole WG, et al. Three weeks of Kirschner wire fixation for displaced lateral condylar fractures of the humerus in children. J Pediatr Orthop, 2001, 21(5): 565-569.
14.	Sharma H, Sibinski M, Sherlock DA. Outcome of lateral humeral condylar mass fractures in children associated with elbow dislocation or olecranon fracture. Int Orthop, 2009, 33(2): 509-514.
15.	Buijze G, Kloen P. Clinical evaluation of locking compression plate fixation for comminuted olecranon fractures. J Bone Joint Surg (Am), 2009, 91(10): 2416-2420.
16.	Baecher N, Edwards S. Olecranon fractures. J Hand Surg (Am), 2013, 38(3): 593-604.
17.	Siebenlist S, Schmidt-Horlohé K, Hoffmann R, et al. Proximal ulna fractures. Z Orthop Unfall, 2011, 149(3): e1-e19.
18.	Givon U, Pritsch M, Levy O, et al. Monteggia and equivalent lesions. A study of 41 cases. Clin Orthop Relat Res, 1997, (337): 208-215.

1. Bado JL. The Monteggia lesion. Clin Orthop Relat Res, 1967, (50): 71-86.
2. Jamses HB, James RK. Fractures in Children. 7th ed. Philadelphia: Lippincott Williams&Wilkins, 2010: 446-450.
3. Sferopoulos NK. Monteggia type IV equivalent injury. Open Orthop J, 2011, 5: 198-200.
4. Güven M, Eren A, Kadio?lu B, et al. The results of treatment in pediatric Monteggia equivalent lesions. Acta Orthop Traumatol Turc, 2008, 42(2): 90-96.
5. Ravessoud FA. Lateral condylar fracture and ipsilateral ulnar shaft fracture: Monteggia equivalent lesions? J Pediatr Orthop, 1985, 5(3): 364-366.
6. Arora S, Sabat D, Verma A, et al. An unusual monteggia equivalent: a case report with literature review. J Hand Microsurg, 2011, 3(2): 82-85.
7. Sood A, Khan O, Bagga T. Simultaneous monteggia type I fracture equivalent with ipsilateral fracture of the distal radius and ulna in a child: a case report. J Med Case Reports, 2008, 2: 190.
8. Gaston MS, Irwin GJ, Huntley JS. Lateral condyle fracture of a child’s humerus: the radiographic features may be subtle. Scott Med J, 2012, 57(3): 182.
9. Fowles JV, Kassab MT. Observations concerning radial neck fractures in children. J Pediatr Orthop, 1986, 6(1): 51-57.
10. Klitscher D, Richter S, Bodenschatz K, et al. Evaluation of severely displaced radial neck fractures in children treated with elastic stable intramedullary nailing. J Pediatr Orthop, 2009, 29(7): 698-703.
11. Toh S, Tsubo K, Nishikawa S, et al. Long-standing nonunion of fractures of the lateral humeral condyle. J Bone Joint Surg (Am), 2002, 84-A(4): 593-598.
12. 張立軍, 吉士俊. 重視肱骨外髁骨折的規范化治療. 中國矯形外科雜志, 2012, 20(18): 1633-1637.
13. Thomas DP, Howard AW, Cole WG, et al. Three weeks of Kirschner wire fixation for displaced lateral condylar fractures of the humerus in children. J Pediatr Orthop, 2001, 21(5): 565-569.
14. Sharma H, Sibinski M, Sherlock DA. Outcome of lateral humeral condylar mass fractures in children associated with elbow dislocation or olecranon fracture. Int Orthop, 2009, 33(2): 509-514.
15. Buijze G, Kloen P. Clinical evaluation of locking compression plate fixation for comminuted olecranon fractures. J Bone Joint Surg (Am), 2009, 91(10): 2416-2420.
16. Baecher N, Edwards S. Olecranon fractures. J Hand Surg (Am), 2013, 38(3): 593-604.
17. Siebenlist S, Schmidt-Horlohé K, Hoffmann R, et al. Proximal ulna fractures. Z Orthop Unfall, 2011, 149(3): e1-e19.
18. Givon U, Pritsch M, Levy O, et al. Monteggia and equivalent lesions. A study of 41 cases. Clin Orthop Relat Res, 1997, (337): 208-215.

《中國修復重建外科雜志》

兒童類孟氏骨折的分型與治療

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兒童類孟氏骨折的分型與治療

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