摘要
目的评价弹性髓内针固定治疗大龄儿童严重移位肱骨近端骨折的疗效。方法回顾分析2009年4月-2012年7月,采用2根弹性髓内针逆行固定治疗的31例严重移位肱骨近端骨折患儿临床资料。男23例,女8例;年龄10~15岁,平均12.8岁。致伤原因:运动伤16例,交通事故伤11例,高处坠落伤4例。伤后至手术时间为6 h^7 d,平均72 h。骨折按Neer-Horwitz分型标准:Ⅲ型17例,Ⅳ型14例;按部位分为干骺端骨折21例,骨骺骨折10例。结果骨折均获得满意复位及稳定固定,其中闭合复位23例,开放复位8例。术后切口均Ⅰ期愈合,无感染、血管神经损伤等并发症发生。患儿均获随访,随访时间12~36个月,平均20个月。X线片复查示骨折均愈合,愈合时间7~10周,平均8周。随访期间无因骺板早闭或骨桥形成导致的患肢生长紊乱和成角畸形。末次随访时,肩关节功能Neer评分为83~100分,平均95.7分。患儿肩关节外形、活动均正常,无疼痛;患侧上肢长度为(67.68±2.56)cm,与健侧(67.61±2.54)cm比较,差异无统计学意义(t=—1.867,P=0.072)。结论弹性髓内针固定治疗大龄儿童严重移位肱骨近端骨折安全、有效,并发症少。
Objective To evaluate the effectiveness of titanium elastic nails for severe displaced proximal humeral fractures in older children. Methods Between April 2009 and July 2012, 31 cases of severe displaced proximal humeral fractures were treated with closed or open reduction and fixation with 2 titanium elastic nails, and the clinical data were retrospectively analyzed. There were 23 boys and 8 girls, aged from 10 to 15 years （mean, 12.8 years）. The causes of injury were sports injury （16 cases）, traffic accident （11 cases）, and falling from height （4 cases）. The interval from injury to operation was 6 hours to 7 days （mean, 72 hours）. According to Neer-Horwitz classification, 17 cases were rated as type III fracture and 14 cases as type IV fracture. There were 21 cases of metaphyseal fractures and 10 cases of epiphyseal fractures. Results Satisfactory reduction of fracture and stable fixation were obtained in all patients （closed reduction in 23 cases and open reduction in 8 cases）. Primary healing was achieved in all incisions; no infection and neurovascular injury occurred. All patients were followed up 12-36 months with an average of 20 months. X-ray films showed that all fractures healed at 7-10 weeks （mean, 8 weeks）. During follow-up, no disturbance of development or angulation deformity caused by premature physeal closure or bone bridge formation was observed. At last follow-up, the average Neer score of the shoulder was 95.7 （range, 83-100）. The appearance and motion of the shoulder were normal. There was no significant difference in the upper extremity length between affected side and contralateral side [（67.68 ± 2.56） cm vs. （67.61 ± 2.54） cm; t= — 1.867, P=0.072]. Conclusion Titanium elastic nails for severe displaced humeral fractures in older children is a safe and effective method with a low complication incidence.
出处
《中国修复重建外科杂志》
CAS
CSCD
北大核心
2014年第3期345-348,共4页
Chinese Journal of Reparative and Reconstructive Surgery
关键词
肱骨近端骨折
弹性髓内针
内固定
大龄儿童
Proximal humeral fracture
Titanium elastic nail
Internal fixation
Older children
