骨科英文书籍精读（114）｜孟氏骨折（2）
Treatment
The key to successful treatment is to restore the length of the fractured ulna; only then can the dislocated joint be fully reduced and remain stable. In adults, this means an operation through a posterior approach. The ulnar fracture must be accurately reduced, with the bone restored to full length, and then fixed with a plate and screws; bone grafts may be added for safety.
The radial head usually reduces once the ulna has been fixed. Stability must be tested through a full range of flexion and extension. If the radial head does not reduce, or is not stable, open reduction should be
performed.
If the elbow is completely stable, then flexion–extension and rotation can be started after very soon after surgery. If there is doubt, then the arm should be immobilized in plaster with the elbow flexed for 6 weeks.
Complications
Nerve injury
Nerve injuries can be caused by overenthusiastic manipulation of the radial dislocation or during the surgical exposure. Always check for nerve function after treatment. The lesion is usually a neurapraxia, which will recover by itself.
Malunion
Unless the ulna has been perfectly reduced, the radial head remains dislocated and limits elbow flexion. In children, no treatment is advised. In adults, osteotomy of the ulna or perhaps excision of the radial head may be needed.
Non-union
Non-union of the ulna should be treated by plating and bone grafting.
Special features in children
The general features of Monteggia fracture-dislocations are similar to those in adults. However, it is important to remember that the ulnar fracture may be incomplete (greenstick or plastic deformation); if this is not detected, and corrected, the child may end up with chronic subluxation of the radial head. Because of incomplete ossification of the radial head and capitellar epiphysis in children, these landmarks may not be easily defined on x-ray and a proximal dislocation could be missed. The x-rays should be studied very carefully and if there is any doubt, x-rays should be taken of the other side for comparison.
Incomplete ulnar fractures can often be reduced closed, although considerable force is needed to straighten the ulna with plastic deformation. The position of the radial head is then checked; if it is not
perfect, closed reduction can be completed by flexing and supinating the elbow and pressing on the radial head. The arm is then immobilized in a cast with the elbow in flexion and supination, for 3 weeks.
Complete fractures are best treated by open reduction and fixation using an intramedullary rod or a small plate.
---from 《Apley’s System of Orthopaedics and Fractures》
拓展：
前臂旋bai前旋后的中立位为握拳拳心向上（du握笔），旋前位为掌心zhi向下；旋后位为掌心向上dao。80-90度。使前臂旋前的肌肉有旋前圆肌和旋前方肌；使前臂旋后的肌肉有旋后肌和肱二头肌。
拓展资料：
旋后肌综合症是桡神经深支(骨间背神经)在旋后肌腱弓附近被卡压，使前臂伸肌功能障碍为主要表现的一种综合征。
旋后肌是肘后一块小肌肉，起于尺骨上端后方桡侧，止于桡骨上段桡侧，分为深浅两层，桡神经深支经旋后肌两层之间穿过，除支配旋后肌外，还支配尺侧腕伸肌、指总伸展肌、食指和小指固有伸肌、拇长、短伸肌及拇长展肌，是一种单纯运动神经，在旋后肌浅层的近侧缘是较坚韧的腱性结构，称为旋后肌腱弓，神经常在此处受压。
重点词汇整理：
overenthusiastic/'əuvərinθju:zi'æstik/adj. 过分热情的
neurapraxia, 机能性麻痹[内科] 神经失用症
百度翻译：
治疗
治疗成功的关键是恢复尺骨骨折的长度，只有这样，脱位关节才能完全复位并保持稳定。对成年人来说，这意味着通过后路手术。尺骨骨折必须精确复位，恢复到全长，然后用770钢板和螺钉固定；为了安全起见，可以增加植骨。
尺骨固定后桡骨头通常会减少。稳定性必须通过全方位的屈曲和伸展进行测试。如果径向头不减小，或不稳定，应打开复位
执行。
如果肘关节完全稳定，术后很快就可以开始屈伸和旋转。如果有疑问，手臂应固定在石膏中，肘部弯曲6周
并发症
神经损伤桡骨脱位操作过度或手术暴露可引起神经损伤。治疗后一定要检查神经功能。病变通常是
神经衰弱，会自行恢复。
畸形愈合除非尺骨已经完全缩小，桡骨头仍然脱臼并限制肘关节的屈曲。对于儿童，不建议治疗。成人可能需要尺骨截骨术或桡骨头切除术。
尺骨不连应采用钢板加植骨治疗。
儿童的特点
孟氏骨折脱位的一般特征与成人相似。然而，重要的是要记住，尺骨骨折可能是不完整的（绿枝或塑性变形）；如果没有发现并纠正这一点，孩子可能会以桡骨头慢性半脱位告终。由于儿童桡骨头和小头骨骺不完全骨化，这些标志物在x光片上可能不易确定，近端脱位可能漏诊。应该仔细研究x光片，如果有任何疑问，应该从另一面拍x光片进行比较。
不完全性尺骨骨折通常可以复位闭合，尽管需要相当大的力量来矫正尺骨的塑性变形。然后检查径向头的位置；如果没有完美的闭合复位可以通过弯曲和旋转肘关节并按压桡骨头来完成。然后用石膏固定手臂，肘关节屈曲和旋后，持续3周。
完全性骨折最好采用切开复位和髓内钉或小钢板固定。