大龄儿童肱骨近端骨折非手术治疗与手术治疗疗效比较

Comparison of non-operative and operative treatments for proximal humeral fractures in older children

目的 比较大龄儿童肱骨近端骨折非手术治疗与手术治疗的临床疗效.方法 从2006年1月至2010年12月,采用手法复位经皮克氏针固定方法治疗大龄儿童肱骨近端骨折24例,非手术方法治疗13例.对手术组与非手术组患儿的肩关节功能、放射学检查结果、肩关节活动度及并发症等资料进行回顾性分析.结果 非手术组平均随访15.8个月（4～37个月）,手术组平均随访17.4个月（5～30个月）,末次随访时骨折均获愈合.手术组复位后残留移位及成角优于非手术组,差异有统计学意义（P＜0.05）.手术组出现术后并发症4例,其中针道反应3例,克氏针穿出肱骨头关节面1例；非手术组,出现复位后骨折再移位1例.术后3个月,两组肩关节活动度、Neer肩关节功能评分比较,差异无统计学意义.与非手术组相比,手术组复位及固定时间与住院时间较长、住院费用较高、患肩开始功能锻炼时间较早、复位后复查X线次数少,两组比较差异有统计学意义（P＜0.05）.结论 大龄儿童肱骨近端骨折手术治疗的复位质量较优,非手术治疗创伤小,费用低,住院时间短,但在术后肩关节功能、活动度及美观上两种治疗方法无明显差异,治疗方式的选择应根据患儿的年龄、骨折类型、软组织损伤程度、合并伤等进行综合考虑.

Objective To compare the outcomes of non-operative and operative treatments of proximal humeral fractures in older children.Methods From January 2006 to December 2010,40 cases of proximal humeral fractures in older children were treated.13 of which by non-operative measure and the remaining 24 patients were treated with manipulative reduction and percutaneous pin fixation.At follow-up,the treatment assessment included radiographic evaluation,detailed physical examination,range of shoulder motion,complications and the assessment of overall shoulder function with the Neer score.Results Our patients were followed up for 4 to 37 months with a mean of 15.8 months in the non-operative group,and 5 to 30 months with a mean of 17.4 months in the operative group.Xray films showed all fractures were healed.Operative group had better quality fracture reduction （P〈0.05）.There were no significant difference between the two groups with regard to range of shoulder motion and the Neer score.Operative group had longer stays,higher in-patients costs,earlier mobilization and less frequency of radiography than non-operative group （P〈0.05）.Conclusions Operative treatment of proximal humeral fractures in older children is better in the quality of fracture reduction.Non-operative treatment has the advantages of minimally invasive,low inpatient cost,short hospital length of stay,but range of shoulder motion and the Neer score are similar in both treatment.Surgical strategy should be made individually based on patients＇ conditions.