儿童孟氏骨折合并骨间背侧神经损伤(附13例报告)

摘要

儿童孟氏骨折合并骨间背侧神经损伤13例,讨论其受伤机制及诊断治疗问题.本组年龄3～12岁.骨折属伸直型12例,屈曲型1例.新鲜骨折4例,陈旧性骨折9例.神经受压4例,神经粘连5例,神经瘢痕化2例,神经断裂2例.治疗方法采用手法或手术复位,手法复位骨折脱位4例,神经松解术5例,神经吻合术4例.10例平均随访2年8个月,9例神经功能恢复正常,1例无效.孟氏骨折合并骨间背侧神经损伤的机制与局部解剖特点有密切关系,是脱位桡骨小头的冲击力、挫伤、压迫、牵拉和粘连等诸因素综合作用所致.强调早期诊断、早期复位可取得满意疗效.晚期病例应积极处理,仍可取得较好效果.%Thirteen cases(aging from 3 to 13 years)of Monteggia's fracture complicated by posterior interosseous nerve injury are reported.The types of fracture included extension type in 12 and flexion in 1.Four cases were fresh fractures and 9 neglected ones.Classification of demage to posterior interosseous nerve revealed nerve compression(4),adhesion(5)and neurotmesis (2).Close or open reduction of the fracture and dislocation of radial head.releasing compression of the nerve were performed on 4 cases,neurolysis on 5 and neuroanastomosis on 4.The resultsof 10 patients followed-up for an average of 2 years and 8 months were satisfactory.Nerve function was restored in 9 and invalid in 1.Conclusion:The rushing force of dislocated radial head,and the contusion,compression,stretching and adhesion of the nerve are all contributory factors of the nerve injury.And the topographic feature is also an improtant factor.Early diagnosis and proper management are stressed to obtain satisfactory results.Attempts should be made to restore the affected nerve to acceptable functions in the delayed cases.