儿童孟氏骨折骨间背侧神经卡压的临床研究.docVIP

  Posterior interosseous nerve entrapment after Monteggia fracture-dislocation in children# Li Hai* 5 10 15 20 (Department of Pediatric Orthopaedics, Xin-Hua Hospital, Shanghai Jiaotong University School of Medicine, ShangHai 200092) Abstract: Object Although most of nerve injuries associated with Monteggia fracture-dislocation in children are neurapraxias and will recover spontaneously after conservative treatment, surgical exploration of the involved nerve is always required in the cases with the entrapment of posterior interosseous nerve (PIN). However, the necessity and time frame for surgical intervention for specific patterns of nerve dysfunction remains controversial. Methods Eight cases, six boys and two girls, with Monteggia fracture-dislocation complicated by PIN injury, managed operatively at the authors’ hospital from 2007 to 2008 were retrospectively reviewed. All the patients underwent the attempted closed reduction, before they received exploration of PIN, with open reduction and internal fixation or successful closed reduction. Results The PIN was found to be trapped acutely posterior to the radiocapitellar joint in 4 out of 5 Type III Bado’s Monteggia fractures. In the remaining cases, since there were longer time intervals from injury to operation, chronic compressive changes and epineural fibrosis of radial nerve were visualized. After a microsurgical neurolysis performed, the complete recovery in the nerve function was obtained in all the cases during the follow-up. Conclusion The findings from this study suggest that every case of type III Monteggia fracture-dislocation with decreased or absent function of muscles innervated by the PIN and an irreducible radial head in child should be viewed as an indication for immediate surgical exploration of the involved nerve to exclude a potential PIN entrapment. Keywords: Monteggia fracture-dislocation; posterior interosseous nerve; entrapment; pediatric 25 0 Introduction Monteggia fracture-dislocati