微型外固定支架治疗儿童孟氏骨折.ppt

单击此处编辑母版标题样式,单击此处编辑母版文本样式,第二级,第三级,第四级,第五级,*,*,广州市儿童医院,文档仅供参考，不能作为科学依据，请勿模仿；如有不当之处，请联系网站或本人删除。,Monteggia Fracture,孟氏骨折,-,前臂骨折,+,近端桡尺关节半脱位或脱位,Giovanni Battista Monteggia 1814,Jose Luis Bado,1958,孟氏骨折,Bado,分型,治疗方法,复位方式：闭合、开放,固定方式：石膏、内固定、,外固定支架,难点,-,术后桡骨头再脱位,男，,10,岁,右侧孟氏骨折,切开复位,+,螺钉内固定,男，,9,岁,左孟氏骨折,闭合复位,+,弹性髓内钉内固定,男，,6,岁,右桡骨头脱位、肘关节脱位,闭合复位,+,石膏外固定,外固定支架治疗孟氏骨折,男，,5,岁,左孟氏骨折,闭合复位,+,外固定架,孟氏骨折的治疗,治疗目的,尺骨骨折稳定的解剖复位,桡骨头维持稳定（,动态稳定,）,应用外固定支架的指征：,手法复位失败,复位后动态不稳,：旋前、旋后、屈曲、伸直时桡骨头不能保持稳定,临床资料,时间：,2010,年,1,月,2014,年,5,月,病例：,16,例,年龄：,1.6,岁,-12,岁 中位数,8.5,岁,随访,6,月,36,月,切开复位,2,例，闭合复位,14,例,Bados,分型,TYPE I,8,（,50%,）,TYPE II,3,（,18.8%,）,TYPE III,4,（,25%,）,TYPE IV,1(6.2,%,),评分标准,Criteria for Assessing Monteggia Treatment as Described by Bruce et al,Range of motion60 points,:%impairment0.6,(%impairment calculated on the basis of the American Medical Association guides for calculation of upper extremity impairment),Activities of daily 20 points,:function equal to opposite arm,living,15 points:no more than 2 activities affected,10 points:unable to perform 3 activities,5 points:unable to perform 4 or more activities,Pain,15 points:no pain,13 points:pain that does not interfere with daily activities,10 points:pain interfering with activity,5 points:pain preventing activities,0 points:pain causing outcries,Anatomy,5 points maximum(1 point for each),Acceptable cosmetic appearance,No angulation,No displacement,No change of carrying angle,Radiographic union,Bruce H E,Harvey J P,Wilson JC Jr.Monteggia fractures.J Bone Joint Surg Am.1974;56:15631576,结果,屈肘功能平均,120(110,130),前臂旋前受限,5(0,10),前臂旋后受限,10(5,15),1,例发生针道感染,关节僵硬,1,例,评分结果,优（,96-100,）,11,（,68.8%,）,良好（,91-95,）,3,（,18.7%,）,一般（,81-90,）,1,（,6.25%,）,差（小于等于,80,）,1,（,6.25%,）,病例,1,闵*,男，,5,岁,左侧孟氏（,III,型）,闭合复位,+,外固定支架固定,术后,1,个月,术后,3,个月,病例,2,严,*,，男，,2,岁，右侧孟氏骨折（,III,型）,动态稳定,切开复位,+,外固定架固定术,术后,2,月,术后,3,月,拆除外固定架,病例,3,罗*男,3,岁“,右侧孟氏骨折,”,外固定技术治疗孟氏骨折的优点,Exner GU.Missed chronic anterior Monteggia lesion.Closed reduction by gradual lengthening and angulation of the ulna.J Bone Joint Surg Br.2001;83:547550,LuX,etal.Management of missed Monteggia fractures with ulnar osteotomy,openreduction,and dual-socket external fixation.J Pediatr Orthop.2013;33:398402,1,、逐步复位，术后可调节,2,、前臂伸直、旋前、旋后、屈曲位时肱桡关节均保持动态稳定,3,、术后即可进行功能锻炼,4,、术后护理方便,结论,应用微型外固定支架治疗动态不稳定儿童孟氏骨折是有效的临床选择之一,Thank You,