儿童肱骨近端骨折合并肩关节脱位的治疗探讨

Treating proximal humeral fractures plus glenohumeral joint dislocation in children

目的儿童肱骨近端骨折合并肩关节脱位罕见,临床治疗方式不统一,本文旨在总结此类损伤的治疗经验。方法回顾性分析苏州大学附属儿童医院骨科2017年1月1日至2022年5月31日收治的5例肱骨近端骨折合并肩关节脱位患儿临床资料,总结患儿影像学特征、治疗方案与预后情况。结果5例中,2例予皮肤牵引治疗,3例予手术治疗,均骨折愈合,末次摄片提示肩关节脱位复位良好;随访2~17个月,肩关节活动无受限、无疼痛。结论儿童肱骨近端骨折合并肩关节脱位可先尝试手法复位及皮肤牵引。对于活动不配合且手法复位失败者,可采取麻醉下穿刺抽液后闭合复位克氏针内固定治疗,如闭合复位失败再行切开复位内固定。

Objective To summarize the experiences of treating proximal humeral fractures plus glenohumeral joint dislocation.Methods From January 1,2017 to May 31,2022,the relevant clinical data were retrospectively reviewed for 5 children of proximal humeral fractures plus glenohumeral joint dislocation.Imaging studies,treatment protocols and healing status were recorded.Results Fractures healed and dislocated shoulder joints were reduced after conservative measures(n=2)and surgery(n=3).Neither pain nor restricted activity occurred during a follow-up period of(2-17)month.Conclusions Close reduction may be initially attempted.For cases not cooperating with joint activities and failing to respond to closed reduction,internal fixation with a Kirschner wire is indicated after puncturing.And open reduction is the last option.