孟氏骨折和盖氏骨折的分类及治疗_培训课件.ppt

孟氏骨折和盖氏骨折的分类及治疗 项 舟 四川大学华西医院骨科 孟氏骨折 尺骨上1/3骨折合并桡骨头脱位 概述 ??? 1914年意大利外科医生Giovanni Monteggia 最早报导了这种类型骨折，故称孟氏骨折。 病因 ??? 多为间接暴力致伤，根据暴力方向及移位情况临床可分三种类型： 伸直型 屈曲型 内收型 伸直型?? 比较常见，多发生儿童。肘关节伸直或过伸位跌倒，前臂旋后掌心触地。作用力顺肱骨传向下前方，先造成尺骨斜形骨折，残余暴力转移于桡骨上端，迫使桡骨头冲破，滑出环状韧带。向前外方脱位。骨折断端向掌侧及桡侧成角。成人直接暴力打击造成骨折，骨折为横断或粉碎型。 Type I (or extension type) - 60% of cases:? ? - anterior dislocation of radial head (or frx) and fracture of ulnar diaphysis at any level w/ anteriorangulation (usually proximal third); - exam: attempt to palpate radial head (ant, post, or lateral); - PIN palsy is most common in type I frx and may occur in a delayed fashion if the radial head is not promptly reduced 屈曲型 多见于成人。肘关节微屈曲，前臂旋前位掌心触地，作用力先造成尺骨较高平面横型或短斜型骨折，桡骨头向后外方脱位，骨折断端向背侧，桡侧成角。 Type II (flexion type) - 15%? ? ? - posterior or posterolateral dislocation of radial head (or frx);? ? ? - frx of proximal ulnar diaphysis with posterior angulation;? ? ? - posterior Monteggia frx is reduced by applying traction to forearm w/ the forearm in full extension;? ? ? ? ? ? - immobilization is continued until there is union of the ulna;? ? ? ? ? ? - this ordinarily requires 6-10 wks depending on the age of pt; 内收型 多发生幼儿。肘关节伸直，前臂旋前位，上肢略内收位向前跌倒，暴力自肘内方推向外方，造成尺骨喙突处横断或纵行劈裂骨折，移位较少，而桡骨头向外侧脱位。 Type III - 20%? ? ? - lateral or anterolateral dislocation of the radial head;? ? ? - fracture of ulnar metaphysis;? ? ? - frx of ulna just distal to coronoid process w/ lateral dislocation of radial head Type IV (5%)? ? ? - anterior dislocation of the radial head;? ? ? - frx of proximal 1/3 of radius frx of ulna at the same level Exam:? ? ? - r/o tear of the annular ligament? ? ? - associated nerve injury:? ? ? ? ? ? - paralysis of deep branch of radial nerve is most common;? ? ? ? ? ? ? ? ? - posterior interosseous nerve may be wrapped around neck of radius, preventing reduction;? ? ? ? ? ? ? ? ? - note: that patients whose operative treatment is delayed may be found to have a progressive PIN palsy from constant? ? ? ? ? ? ? ?