摘要
目的 探讨后孟氏骨折损伤的临床特征及手术疗效.方法 回顾性分析2016年1月至2020年1月收治的19例成人后孟氏骨折损伤的患者资料.其中男13例、女6例;平均年龄(46.8±15.6)岁(21～69岁).尺骨骨折使用解剖锁定钢板固定,桡骨头骨折进行内固定或置换,冠状突骨折使用螺钉或微型钢板固定,内外侧副韧带损伤采用锚钉修复.分析患者的一般资料和骨折脱位的形态特征,并随访术后肘关节功能.结果 Jupiter ⅡA/ⅡD型占比89％(17例),合并尺骨鹰嘴和冠突骨折、桡骨头骨折后脱位、肱尺关节脱位和外尺侧副韧带撕裂的联合损伤.所有患者获平均(20.8±5.3)个月(11～37个月)随访.肘关节平均屈曲为(117.1±18.5)°(90～140°),平均伸直为(18.2±12.7)°(5～45°),平均旋前为(54.2±19.5)°(10～70°),平均旋后为(62.1±20.4)°(10～80°).Broberg-Morrey肘关节功能系统评分平均为(79.8±11.5)分(57～93分).7例患者(37％)发生术后异位骨化,肘关节活动度和功能评分均显著低于无异位骨化的患者(P＜0.05).结论 JupiterⅡA/ⅡD型损伤往往涉及尺骨鹰嘴和冠突骨折、桡骨头骨折后脱位、肱尺关节脱位和外尺侧副韧带撕裂的联合损伤.正确识别损伤特征,并通过合适的手术治疗可以取得良好的效果.
Abstract
Background Monteggia fractures initially referred specifically to fractures of the proximal third of the ulna combined with anterior dislocation of the radial head.In 1967,Bado categorized this injury into four types based on the direction of radial head dislocation and whether there was an associated fracture of the radial shaft.Among these types,Bado Ⅱ,involving posterior dislocation of the radial head in Monteggia injuries,is the most common and complex.Subsequently,Jupiter and others further subdivided Monteggia injuries with posterior dislocation of the radial head based on the location of the ulnar fracture.Most scholars acknowledge that a series of injuries involving proximal ulnar fractures combined with posterior dislocation of the radial head,radial head fractures,or coronoid process fractures should be collectively referred to as posterior Monteggia fracture-dislocations.Dong Jingming and others further proposed that classic Monteggia fractures involve ulnar fractures with a dislocation of the proximal radioulnar joint.When combined with posterior dislocation of the radial head,it is termed posterior Monteggia fracture,whereas those without dislocation of the proximal radioulnar joint are termed post-ulnar proximal fractures with dislocation.Due to the various complex patterns of fractures and dislocations involving the proximal ends of the ulna and radius in posterior Monteggia fractures,it is crucial to understand the extent and nature of the injury.Only by restoring the bony structure and elbow joint stability can satisfactory clinical outcomes be achieved.Objective To investigate the clinical features and operative effect of posterior Monteggia fracture.Methods A retrospective analysis was conducted on data from 19 adult patients with posterior Monteggia fractures treated between January 2016 and January 2020.Among them were 13 males and 6 females,with an average age of(46.8±15.6)years(ranging from 21 to 69 years old).Anatomical locking plates were used for ulnar fractures,while internal fixation or replacement was performed for radial head fractures.Coronoid process fractures were fixed using screws or mini-plates,and repair with anchor nails was employed for injuries to the medial and lateral collateral ligaments.The patients'general information and the morphological characteristics of their fractures and dislocations were analyzed,followed by postoperative follow-up to assess elbow joint function.Results Jupiter ⅡA/ⅡD type accounted for 89％(17 cases),involving combined injuries of the olecranon of the ulna,coronoid process,radial head fractures with dislocation,elbow dislocation,and lateral collateral ligament tear.All patients were followed up for an average of(20.8±5.3)months(ranging from 11 to 37 months).The average flexion of the elbow joint was(117.1±18.5)°(ranging from 90° to 140°),while the average extension was(18.2±12.7)°(ranging from 5° to 45°).The average pronation was(54.2±19.5)°(ranging from 10° to 70°),and the average supination was(62.1±20.4)°(ranging from 10° to 80°).The Broberg-Morrey elbow joint functional system score averaged(79.8±11.5)points(ranging from 57 to 93 points).Seven cases(37％)experienced postoperative heterotopic ossification,resulting in significantly lower elbow joint mobility and functional scores compared to patients without heterotopic ossification(P＜0.05).Conclusion The injuries classified as Jupiter ⅡA/ⅡD often involve combined injuries,including olecranon and coronoid process fractures,radial head fractures with dislocation,elbow dislocation,and lateral collateral ligament tears.Accurately identifying these injury features and employing appropriate surgical treatments can yield favorable outcomes.
维普
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