手術(shù)-尺骨骨折伴橈骨頭脫位切開復(fù)位內(nèi)固定術(shù)

1、1、一般考慮In the adult displaced Monteggia lesion, anatomical reduction and stable fixation are mandatory.The ulna fracture must be anatomically reduced in order to ensure accurate reposition of the radial head.Once operative fixation is achieved, the surgeon must ensure the stability of the radial head

2、, preferably under image intensification.成人孟氏骨折，必須解剖復(fù)位堅強(qiáng)固定。尺骨骨折解剖復(fù)位以確保橈骨頭恢復(fù)到原來的位置。當(dāng)固定完成 時，手術(shù)者必須確保橈骨頭穩(wěn)定，可通過透視確定。Instability of the radial head or incomplete reduction usually suggests a malreduction of the ulna fracture.橈骨頭的不穩(wěn)或不完全復(fù)位，通常原因為尺骨復(fù)位欠滿意。2、孟氏骨折的治療Spontaneous reductionUsually reduction of the

3、radial head spontaneously follows anatomical reduction of the ulna (90%).自發(fā)復(fù)位：橈骨頭復(fù)位通常在尺骨解剖復(fù)位完成后自發(fā)復(fù)位(90%).Open reductionIn the case of incomplete reduction or persistent luxation (10%), soft tissue interposition (joint capsule, annular ligament) has to be suspected and further investigated.切開復(fù)位：對于未完全

4、復(fù)位或不好復(fù)位者，軟組織因素(如關(guān)節(jié)囊，環(huán)狀韌帶)需要探查。Approach to the radial headBoyd approach or separate incision by lateral approach to the radial head.切口選擇：可選Boyd入路或單獨(dú)橈骨頭外側(cè)切口。Stabilization of radial headThe interposed soft tissue structure is reduced and sutured if possible. In cases of late reconstructions a strip of forearm fascia can be used as a new annular ligament.穩(wěn)定橈骨頭：軟組織嵌入結(jié)構(gòu)需要復(fù)位并修復(fù)，如果后期重建可選用前臂筋膜重 建環(huán)狀韌帶。（如下兩圖）Dislocated head oi EdiusPosterior interosseous arteryPosterior intero$eou$ arteryStrip of deep fascia pas