儿童类孟氏骨折的分型与治疗_《中国修复重建外科杂志》

作者：

于铁强 , 左玉明 , 王月光 , 周宏艳 , 王国强 , 易凡 , 张磊 , 王晶 , 邢爱春 , 马建凤

唐山市第二医院小儿骨科（河北唐山，063000）;

关键词：

类孟氏骨折骨折分型标准内固定儿童

DOI：

10.7507/1002-1892.20130286

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目的探讨儿童类孟氏骨折的分型标准及手术治疗方法和疗效。方法回顾性分析2008年1月－2012年1月收治的35例类孟氏骨折患儿临床资料。男17例，女18例；年龄1岁2个月～14岁11个月，平均7岁5个月。致伤原因：跌伤25例，摔伤3例，运动伤7例。受伤至入院时间1 h～16 d，中位时间28 h。根据自定义骨折分型标准：Ⅰ型为尺骨骨折（包括鹰嘴）伴桡骨颈骨折或桡骨近端骨骺损伤，22例；Ⅱ型为肘关节后脱位伴桡骨颈骨折或桡骨近端骨骺损伤，2例；Ⅲ型为尺骨和/或鹰嘴骨折伴肱骨外髁骨折，10例；Ⅳ型为尺、桡骨骨折伴桡骨颈骨折或桡骨近端骨骺损伤，1例。根据分型结果，对骨折复位后行内固定或辅助石膏外固定。结果术后患儿切口均Ⅰ期愈合，无切口感染等并发症发生。34例患儿获随访，随访时间12～18个月，平均14个月。X线片复查示，骨折均愈合，骨折愈合时间6周～5 个月，平均2.5个月。末次随访时，采用改良肘关节美国特种外科医院（HSS）评分评价疗效，获优29例，良4例，可2例，优良率达94%。无肘内、外翻及迟发性尺神经炎等并发症发生。结论与传统分型标准相比，自定义分型标准简单易记，有利于减少漏诊率及选择治疗方法；手术是治疗儿童类孟氏骨折的有效方法。

引用本文： 于铁强,左玉明,王月光,周宏艳,王国强,易凡,张磊,王晶,邢爱春,马建凤. 儿童类孟氏骨折的分型与治疗. 中国修复重建外科杂志, 2013, 27(11): 1309-1312. doi: 10.7507/1002-1892.20130286 复制

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, Kadioğlu 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.	张立军, 吉士俊. 重视肱骨外髁骨折的规范化治疗. 中国矫形外科杂志, 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, Kadioğlu 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. 张立军, 吉士俊. 重视肱骨外髁骨折的规范化治疗. 中国矫形外科杂志, 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.

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儿童类孟氏骨折的分型与治疗

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《中国修复重建外科杂志》

儿童类孟氏骨折的分型与治疗

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