新鲜BadoⅣ型孟氏骨折的治疗与远期随访

陈涵 李明

摘 要：目的 探究新鲜BadoⅣ型孟氏骨折的治疗方式、远期疗效。方法 选取2012年1月～2015年12月在我院治疗并随访的有较完整资料的BadoⅣ型孟氏骨折21例，其中2例采用手法复位，11例采用尺桡骨克氏针固定，5例采用尺骨克氏针固定，2例采用尺骨髓内钉固定，1例采用尺骨髓内钉固定+桡骨克氏针固定。采用Mayo评分系统进行远期疗效评价。结果 21例均获得治疗后2～5年远期随访，平均随访（3.92±2.53）年。Mayo评分优16例，良4例，一般1例，优良率95.24%。结论 BadoⅣ孟氏骨折损失机制特殊，应及时治疗，治疗上以手术治疗最常见，术后尽早行肘功能锻炼，多数可获得满意远期预后。

关键词：孟氏骨折；手法复位；内固定；远期随访

中图分类号：R726.8 文献标识码：B DOI：10.3969/j.issn.1006-1959.2018.09.061

文章编号：1006-1959（2018）09-0182-03

Abstract：Objective To explore the treatment and long-term effect of fresh Bado type IV Monteggia fracture.Methods From January 2012 to December 2015，21 cases of Bado type Ⅳ Monteggia fractures were treated and followed up in our hospital.Among them，2 cases were treated with manual reduction and 11 cases were fixed with the ulnar and radial Kirschner wire，5 cases were fixed by the ulna Kirschner pin.2 cases were fixed with ulnar intramedullary nail and 1 cases were fixed with ulnar intramedullary nailing and radial Kirschner wire fixation.The Mayo scoring system was used to evaluate the long-term effect.Results All the 21 patients were followed up from 2 to 5 years after treatment.The mean follow-up was（3.92±2.53）years.The Mayo score was excellent in 16 cases， good in 4 cases，general in 1 case，with a good rate of 95.24 %.Conclusion The mechanism of Bado type IV Monteggia fracture loss is special.It should be treated in time.The most common surgical treatment is to be treated by operation.The early elbow function exercise is done as early as possible.Most of them can get satisfactory long-term prognosis.

Key words：Monteggia Fracture；Manual reduction；Internal fixation；Long-term follow-up

BadoⅣ型孟氏骨折是指尺、橈骨近端双骨折伴桡骨头脱位，是一种损伤较重，较为罕见的孟氏骨折类型，若未采取有效的治疗，往往会发展造成严重的功能障碍和外观畸形。目前对于诊断明确的孟氏骨折，多采用手术治疗。 本文对资料较为完整的21例Bado IV型新鲜孟氏骨折进行远期随访，旨在观察此类新鲜孟氏骨折的治疗方式与远期疗效。 1 资料与方法

1.1 一般资料 选取重庆医科大学附属儿童医院2012年1月～2015年12月临床诊断为BadoⅣ型孟氏骨折的患儿21例，其中男性6例，女性15例，年龄2～13 岁，平均年龄（7.16±3.85）岁。摔伤13例，高处跌落伤5例，车祸伤3例。左侧13例，右侧8例；伴桡神经损伤7例，开放骨折1例。伤后手术时间1～5 d，平均时间（3.62±1.05）d。随访时间2～5年，平均（3.92±2.53）年。

1.2方法

1.2.1 手法复位+石膏外固定术 2例复位后行石膏外固定术，复查X片骨折对位对线良好。……