超声与MRI在儿童孟氏骨折中的应用进展

Progress in the Application of Ultrasound and MRI in Pediatric Monteggia Fractures

摘要: 儿童孟氏骨折是一种发生率较低但损伤复杂的儿童上肢骨折，核心表现为尺骨骨折合并桡骨头脱位，因儿童肘部骨化中心发育特点、检查不配合等因素，桡骨头脱位易漏诊。诊断需结合临床表现、体格检查及影像学检查，X线是基础诊断手段，超声可动态、无辐射评估肱桡关节及环状韧带情况，MRI能清晰显示软组织损伤与环状韧带状态，CT三维重建可辅助畸形可视化。急性病例以闭合复位联合石膏固定为主要保守治疗方式，漏诊或延误治疗易进展为陈旧性孟氏骨折，需手术干预且术后并发症风险较高。本文综述儿童孟氏骨折的临床表现、多模态影像学诊断进展、治疗策略及陈旧性病变诊疗难点，为临床早期精准诊断、减少漏诊及优化治疗方案提供参考。

Abstract: Monteggia fracture in children is a type of upper limb fracture with low incidence but complex injury mechanism, characterized by ulnar fracture combined with radial head dislocation. Due to the immature development of ossification centers in the elbow joint of children and poor cooperation during examinations, radial head dislocation is highly prone to missed diagnosis. Clinical diagnosis should be based on the combination of clinical manifestations, physical examinations and multimodal imaging findings: X-ray examination serves as the basic diagnostic method; ultrasound enables dynamic and radiation-free evaluation of the humeroradial joint alignment and annular ligament integrity; MRI can clearly display the degree of soft tissue injury and the injury status of the annular ligament; and three-dimensional CT reconstruction can assist in the visualization of fracture deformities. For acute Monteggia fracture in children, closed reduction combined with plaster external fixation is the preferred conservative treatment option; cases with missed or delayed diagnosis are likely to progress to chronic Monteggia fracture, which mostly require surgical intervention and are associated with a significantly increased risk of postoperative complications. This paper reviews the clinical manifestations, multimodal imaging diagnostic progress, treatment strategies as well as the diagnosis and treatment difficulties of chronic lesions of Monteggia fracture in children, aiming to provide references for early clinical accurate diagnosis, reduction of missed diagnosis and optimization of treatment regimens.