微创切口复位改良外固定架治疗儿童肱骨外科颈骨折

Treatment of Children′s Surgical Neck Fractures in Humerus with Minimally Invasive Incision Reduction and Modified External Fixation

目的探讨改良外固定架治疗儿童肱骨外科颈骨折的可行性及疗效。方法 2005年3月-2010年12月对21例肱骨外科颈骨折的儿童患者采用微创切口复位改良外固定架固定术。患儿术前均摄肩关节正位X线片及CT扫描三维重建,均为不稳定型骨折。男15例,女6例;年龄6～15岁。其中闭合骨折18例,开放骨折3例。术后复查X线了解骨折愈合情况,并根据Neer功能评分系统评定恢复情况。结果术后随访6个月～3 a。术后6～8周骨折愈合,术后2个月去除外固定架。Neer功能评分,优16例,良5例,优良率100%。肩关节功能均在术后3～4周基本恢复正常,骨骺发育未见异常。2例随访至17岁,患侧肢体未见发育畸形和肢体短缩。结论近端克氏针替代螺钉,可避免损伤骨骺,小切口骨折解剖复位辅以外固定架固定治疗儿童肱骨外科颈骨折疗效满意。

Objective To evaluate the feasibility and efficacy of modified external fixation in the treatment of surgical neck fractures in the humerus in children. Methods Twenty-one children with surgical neck fractures of the humerus children were selected from Mar.2005 to Dec.2010 in the First Affiliated Hospital of Xinxiang Medical University.According to pre-operative X-ray and three-dimensional CT,all cases belonged to unstable fractures.Neer fracture classification system was used.Twenty-one cases included 15 male and 6 female and the average age was 6-15 years old.Among them 18 cases were closed fractures and 3 cases were open fractures.Then the fracture healing was observed by X-ray and the function according to Neer fracture classification system after operation. Results The follow-up period was 6 months to 3 years.All fractures were healed 6 to 8 weeks after operation and removed external fixation 2 months after operation.According to Neer fracture classification system,the outcome was excellent in 16 cases,fairly good in 5 cases,and the curative rate was 100%.All cases were returned to barrier-free shoulder function and no epiphyseal dysplasia 3 to 4 weeks after surgery.In which,2 cases were followed up for 17 years,without deformity and limbs shortens. Conclusions Using Proximal Kirschner wire insteaded of screws can avoid epiphysis injury and minimal invasive operation can achieve anatomic reduction of fracture.The surgical neck fractures in the humerus in children treated by this method combined with external fixation can reach satisfactory effect.