切换至 "中华医学电子期刊资源库"

中华肩肘外科电子杂志 ›› 2023, Vol. 11 ›› Issue (04) : 338 -343. doi: 10.3877/cma.j.issn.2095-5790.2023.04.007

论著

后孟氏骨折损伤的临床特征及手术疗效分析
郑金文, 向明(), 陈杭, 胡晓川, 李一平, 张清, 杨金松   
  1. 610041 成都,四川省骨科医院上肢科
  • 收稿日期:2023-08-20 出版日期:2023-11-05
  • 通信作者: 向明

Analysis of the clinical characteristics and postoperative effect of posterior Monteggia fracture

Jinwen Zheng, Ming Xiang(), Hang Chen, Xiaochuan Hu, Yiping Li, Qing Zhang, Jinsong Yang   

  1. Department of Upper Extremity, Sichuan Orthopaedic Hospital, Chengdu 610041, China
  • Received:2023-08-20 Published:2023-11-05
  • Corresponding author: Ming Xiang
引用本文:

郑金文, 向明, 陈杭, 胡晓川, 李一平, 张清, 杨金松. 后孟氏骨折损伤的临床特征及手术疗效分析[J/OL]. 中华肩肘外科电子杂志, 2023, 11(04): 338-343.

Jinwen Zheng, Ming Xiang, Hang Chen, Xiaochuan Hu, Yiping Li, Qing Zhang, Jinsong Yang. Analysis of the clinical characteristics and postoperative effect of posterior Monteggia fracture[J/OL]. Chinese Journal of Shoulder and Elbow(Electronic Edition), 2023, 11(04): 338-343.

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

Jupiter IIA/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。

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.

表1 患者的临床特征
图1 67岁女性患者,行走摔伤。术前X线片显示Jupiter IIB型损伤,伴桡骨头Mason II型骨折(图A-B);使用锁定解剖板固定尺骨,使用微型螺钉固定桡骨头片(图C-D);术后2年X线片显示肘关节无异位骨化和退行性变化发生(图E-F);获得满意的功能结局(图G-J)
图2 46岁男性患者,高坠伤。术前X线片及CT显示Jupiter IIA型损伤,伴桡骨头Mason III型骨折,伴冠状突Regan–Morrey III型骨折,伴肱尺关节后脱位(图A-C);使用锁定解剖板联合张力带钢丝固定尺骨,前方入路使用微型螺钉钢板固定冠状突,使用微型螺钉钢板固定桡骨头,锚钉修复外尺侧副韧带(图D-E);术后1年X线片显示肘关节无异位骨化和退行性变化发生(图F-G);获得满意的功能结局(图H-K)
[1]
Monteggia GB. Lussazioni delle ossa delle estremita superiori[J]. Instituzioni Chirurgiches, 1814, 5:131-133.
[2]
Bado JL. The Monteggia lesion[J]. Clin Orthop Relat Res, 1967, 50(1): 71-86.
[3]
Jupiter JB, Leibovic SJ, Ribbans W, et al. The Posterior Monteggia Lesion[J]. J Orthop Trauma, 1991, 5(4): 395-402.
[4]
Tashjian RZ.The unstable elbow: an evidence-based approach to evaluation and management[M]. Switzerland: Springer Nature, 2017:85-87.
[5]
东靖明, 刘俊阳, 马宝通, 等. 成人后孟氏骨折与经尺骨近端骨折后脱位的鉴别与治疗 [J]. 中华骨科杂志,2020,40 (1): 60-64.
[6]
杨国勇, 向明, 陈杭,等. 肘前内侧结合Kocher入路双切口一期修复骨性和韧带结构治疗肘关节脱位伴尺骨冠状突骨折的短期疗效分析[J]. 中国运动医学杂志, 2016,35(2):24-28.
[7]
Ring D, Jupiter JB, Waters PM, et al. Monteggia Fractures in Children and Adults[J]. J Am Academy Orthop Surg, 1998, 6(4): 215-224.
[8]
李庭, 蒋协远, 张健, 等. 成人尺骨近端向后孟氏损伤的诊断与治疗[J]. 中华外科杂志, 2009, 47(12):899-902.
[9]
Strauss EJ, Tejwani NC, Preston CF, et al. The posterior Monteggia lesion with associated ulnohumeral instability[J]. J Bone Joint Surg, 2006, 88(1): 84-89.
[10]
Scolaro JA, Beingessner DM. Treatment of Monteggia and transolecranon fracture-dislocations of the elbow: a critical analysis review[J]. JBJS Rev, 2014, 2(1):e2.
[11]
Matar HE, Akimau PI, Stanley D, et al. Surgical treatment of Monteggia variant fracture dislocations of the elbow in adults: surgical technique and clinical outcomes[J]. Eur J Orthop Surg Traumatol, 2017, 27(5): 599-605.
[12]
Calderazzi F, Galavotti C, Nosenzo A, et al. How to approach Monteggia-like lesions in adults: A review[J]. Ann Med Surg(Lond), 201835: 108-116.
[13]
Jungbluth P, Tanner S, Schneppendahl J, et al. The challenge of Monteggia-like lesions of the elbow: mid-term results of 46 cases[J]. Bone Joint J, 2018100(2): 212-218.
[14]
Egol KA, Tejwani NC, Bazzi J, et al. Does a Monteggia Variant Lesion Result in a Poor Functional Outcome?: A Retrospective Study[J]. Clin Orthop Related Res, 2005, 438(438): 233-238.
[15]
Liu JY, Zhang JZ, Wang YM, et al. Difference Between Posterior Monteggia Fractures and Posterior Fracture-Dislocation of Proximal Ulna in Adults[J]. Orthop Surg, 2020,12(5):1448-1455.
[16]
Konrad G, Kundel K, Kreuz PC, et al. Monteggia fractures in adults: long-term results and prognostic factors [J]. J Bone Joint Surg, 2007, 89(3): 354-360.
[17]
Klug A, Konrad F, Gramlich Y, et al. Surgical treatment of the radial head is critical to the outcome of Monteggia-like lesions[J]. J Bone Joint Surg, 2019,101-B(12): 1512-1519.
[1] 孙佳丽, 金琳, 沈崔琴, 陈晴晴, 林艳萍, 李朝军, 徐栋. 机器人辅助超声引导下经皮穿刺的体外实验研究[J/OL]. 中华医学超声杂志(电子版), 2024, 21(09): 884-889.
[2] 李刘庆, 陈小翔, 吕成余. 全腹腔镜与腹腔镜辅助远端胃癌根治术治疗进展期胃癌的近中期随访比较[J/OL]. 中华普外科手术学杂志(电子版), 2025, 19(01): 23-26.
[3] 刘世君, 马杰, 师鲁静. 胃癌完整系膜切除术+标准D2根治术治疗进展期胃癌的近中期随访研究[J/OL]. 中华普外科手术学杂志(电子版), 2025, 19(01): 27-30.
[4] 李华志, 曹广, 刘殿刚, 张雅静. 不同入路下行肝切除术治疗原发性肝细胞癌的临床对比[J/OL]. 中华普外科手术学杂志(电子版), 2025, 19(01): 52-55.
[5] 常小伟, 蔡瑜, 赵志勇, 张伟. 高强度聚焦超声消融术联合肝动脉化疗栓塞术治疗原发性肝细胞癌的效果及安全性分析[J/OL]. 中华普外科手术学杂志(电子版), 2025, 19(01): 56-59.
[6] 韩戟, 杨力, 陈玉. 腹部形态CT参数与完全腹腔镜全胃切除术术中失血量的关系研究[J/OL]. 中华普外科手术学杂志(电子版), 2025, 19(01): 88-91.
[7] 王露, 周丽君. 全腹腔镜下远端胃大部切除不同吻合方式对胃癌患者胃功能恢复、并发症发生率的影响[J/OL]. 中华普外科手术学杂志(电子版), 2025, 19(01): 92-95.
[8] 孙一娇, 包润发, 董平, 束翌俊. PBL结合手术视频剪辑教学在普通外科专科医师规范化培训中的应用与思考[J/OL]. 中华普外科手术学杂志(电子版), 2025, 19(01): 96-99.
[9] 陈浩, 王萌. 胃印戒细胞癌的临床病理特征及治疗选择的研究进展[J/OL]. 中华普外科手术学杂志(电子版), 2025, 19(01): 108-111.
[10] 孙莲, 马红萍, 吴文英. 局部进展期甲状腺癌患者外科处理[J/OL]. 中华普外科手术学杂志(电子版), 2025, 19(01): 112-114.
[11] 刘柏隆. 女性压力性尿失禁阶梯治疗之手术治疗方案选择[J/OL]. 中华腔镜泌尿外科杂志(电子版), 2025, 19(01): 126-126.
[12] 刘柏隆, 周祥福. 女性尿失禁吊带手术并发症处理的经验分享[J/OL]. 中华腔镜泌尿外科杂志(电子版), 2025, 19(01): 127-127.
[13] 周迪, 全志伟. 规范化胆囊良性疾病诊治流程减少胆囊癌误诊误治[J/OL]. 中华肝脏外科手术学电子杂志, 2024, 13(06): 749-753.
[14] 张耕毓, 唐冲, 张昆, 张辉, 张清华, 刘家帮. 股骨头坏死髓芯减压术的文献计量学分析及单中心病例报道[J/OL]. 中华临床医师杂志(电子版), 2024, 18(08): 771-780.
[15] 胡云鹤, 周玉焯, 付瑞瑛, 于凡, 李爱东. CHS-DRG付费制度下GB1分组住院费用影响因素分析与管理策略探讨[J/OL]. 中华临床医师杂志(电子版), 2024, 18(06): 568-574.
阅读次数
全文


摘要