摘要
目的比较克氏针（K—wires）、接骨板（Plate）、弹性髓内针（elastic stable intramedullary nailing，ESIN）技术治疗大龄儿童肱骨近端骨折的临床疗效。方法回顾性分析2006年6月至2012年12月我科收治且获得随访的84例大龄儿童肱骨近端骨折手术患儿的临床资料。根据内固定方式不同，分为切开复位克氏针固定组（32例）、切开复位接骨板内固定组（16例）及弹性髓内针逆行髓内内固定组（36例）。年龄8～14岁，平均年龄11．6岁。男48例，女36例。左侧31例，右侧53例。对三组患儿手术时间、术中出血量、手术切口瘢痕长度、术后住院时间、术后的影像学结果、骨折愈合时间、术后并发症及肩关节Constant评分进行比较。结果所有患儿术后均获8～24个月（平均13个月）随访。K-wires、Plate、ESIN组的手术时间分别为（72±10）、（82±14）和（48±8）min，术中出血量分别为（50±6）、（64±7）和（25±6）ml，手术切口瘢痕长度分别为（6．2±1．9）、（8．2±2．8）和（4．0±2．1）cm，骨折临床愈合时间分别为（8．8±0．7）、（9．2±0．9）和（8．2±0．8）周，术后发生并发症比例分别为2／32、（3／16和2／36，术后6个月肩关节Constant评分优良率分别为90．7％（29／32）、93．7％（15／16）、和94．4％（34／36）。弹性髓内针髓内逆行内固定组患儿在手术时间、术中出血量、手术切口瘢痕长度明显优于切开复位克氏针组及切开复位接骨板内固定组（P〈0．05）。而三组患儿在术后住院时间、骨折愈合时间、术后影像学结果及肩关节Constant评分比较均无统计学意义（P〉0．05）。三组病例均未发生骨不愈合及肱骨头坏死。结论三种内固定方式治疗大龄儿童肱骨近端骨折在术后肩关节功能评估、骨折愈合时间及术后影像学结果上无显著差异。从手术时间、手术瘢痕、术中出血量等方面进行综合比较，弹性髓内针组优于克氏针及接骨板组，具有微创，术中出血少，手术时间短，手术瘢痕小等优点，是临床治疗大龄儿童肱骨近端骨折优先的治疗选择。
Objective To compare three internal fixation methods for the treatment of acute proximal humeral fractures in elderly children. Methods From June 2006 to December 2012,84 elderly children treated in our department for acute proximal humeral fractures were retrospectively reviewed. K-wires were used in 32 patients, Plate fixation in 16 patients, and retrograde elastic stable intramedullary nailing technique in 36 patients. There were 48 males and 36 females with an average age of 11.6 （8--14） years. The left side was involved in 31 cases and right in 53. The data of operative time,intra-operative blood loss, wound length, hospital stay, time for union, complication rates, and Constant score of the shoulder were recorded in the three groups and compared statistically. Results The mean follow-up was 13 months （range,8-24 months）. The operative time was （72 ± 10）, （82 ± 14） and （48 ± 8）rain, the volume of bleeding was （50 ± 6）, （64 ± 7） and （25 ± 6）ml, the wound length was （6. 2 ± 1.9）, （8. 2 ± 2. 8） and （4. 0 ± 2. 1）cm, the clinical fracture healing time was （8. 8 ± 0. 7）, （ 9. 2 ± 0. 9 ）, and （ 8. 2 ± 0. 8 ） weeks, and the postoperative complication rates were 2 / 32,0 / 16, and 2 / 36, the Constant scores of good and excellent 6 months after surgery were 90. 7% （29/32）,93. 7% （15/16）, and 94. 4% （34/36）, in K-wires, Plate, and ESIN groups, respectively. The operative time, intra-operative blood loss, and incision size in retrograde ESIN technique group were significantly prior to those in the other two groups（P^0. 05）. However, the time for union, length of hospital stay postoperatively, and the Constant score were not significantly different among the three groups （P〉0. 05）. Conclusions The functional outcomes are similar in older children （older than 8） with acute proximal humeral fractures treated by K-wire, Plate, or ESIN techniques. The retrograde ESIN technique has the advantages of less operative invasion, shorter operative time, less intra-operative blood loss, shorter incision size,and satisfactory shoulder functional recovery. Therefore, for fresh proximal humeral fractures, retrograde ESIN technique is more effective and should be a priority selection.
出处
《中华小儿外科杂志》
CSCD
北大核心
2014年第1期6-10,共5页
Chinese Journal of Pediatric Surgery
关键词
肱骨骨折
骨折固定术
内
切开复位
Humerus fractures
Fracture fixation, internal
Open reduction
