手法闭合复位结合外固定架治疗儿童肱骨干骨折的临床观察

Treatment of humeral shaft fractures in children with closed reduction and external fixation

目的 :探讨闭合复位微创治疗儿童肱骨干骨折的临床疗效。方法 :2011年7月至2015年4月采用手法闭合复位结合外固定架固定治疗39例儿童肱骨干骨折,男27例,女12例;年龄3~14岁,平均8.6岁;受伤至治疗时间2 h^7 d,平均2.7 d;其中上段骨折6例,中段骨折21例,下段骨折12例。所有患儿为闭合性损伤,损伤后出现疼痛、肿胀、局部畸形及活动受限等症状,X线检查提示肱骨干骨折。采用肩关节功能Neer评分及肘关节功能HSS评分记录并对比分析治疗前后肩肘关节疼痛、功能、活动度。结果:39例患者均获随访,时间6~12个月,平均8.6个月。术后2例出现针道浅表感染,经换药愈合;其他病例针孔愈合良好。治疗前后肩关节Neer各项评分和总分比较差异均有统计学意义(P<0.01),治疗前后肘关节HHS疼痛、功能及总分比较差异均有统计学意义(P<0.01)。末次随访患者肩关节功能Neer评分为88.82±2.50,其中优29例,良9例,可1例;肘关节功能HSS评分为91.51±5.09,其中优秀30例,良好7例,一般2例。结论:手法闭合复位结合外固定架治疗儿童肱骨干骨折,具有创伤小、复位效果确切、固定可靠、利于肩肘关节早期功能锻炼等优点,此疗法可作为临床上治疗儿童肱骨干骨折的方法之一。

Objective：To explore the clinical effect of closed reduction and minimally invasive treatment of humeral shaft fractures in children. Methods：From July 2011 to April 2015,39 cases of pediatric humeral shaft fractures were treated by closed reduction and external fixation,including 27 males and 12 females with a mean age of 8.6 years old ranging from 3 to 14 years old. Time from injury to the treatment was 2 h to 7 days with an average of 2.7 days. There were 6 cases of upper fracture,21 cases of middle fracture and 12 cases of lower fracture. All children were closed injury,appeared pain,swelling,local deformity and limited mobility and other symptoms after injury. X ray examination showed humeral shaft fracture. Neer score of shoulder joint function and HSS score of elbow joint function were used to record and analyze the pain,function and activity of shoulder and elbow joint before and after treatment. Results：All the 39 cases were followed up for 6 to 12 months with a mean of 8.6 months. Two cases appeared postoperative superficial infection of the needle,and healed after dress; other cases gained good pinhole healing. There were significant differences in the pain,function and activity of the shoulder of Neer score before and after the treatment（P〈0.05）. There were significant differences in the pain and function of the elbow of HSS before and after treatment（P〈0.05）. According to the evaluation of Neer score of shoulder function,the total score was 88.82±2.50,29 cases were excellent,9 cases were good,and 1 case was fair. According to the evaluation of HSS score of elbow joint function evaluation,the total score was 91.51±5.09,30 cases were excellent,7 cases were good,2 cases were general. Conclusion：Manual closed reduction combined with external fixation for the treatment of humeral shaft fractures in children has advantages of less trauma,definite reduction effect,reliable fixation and benefit for early functional exercise of the shoulder and elbow joint. This therapy can be used as one of clinical methods for the treatment of humeral shaft fractures in children.