经皮穿针内固定和闭合复位外固定治疗儿童肱骨近端骨骺分离的疗效比较

Clinical effects of two fixation methods on treatment of proximal humerus epiphyseal separation in children

目的比较经皮穿针内固定和闭合复位外固定治疗儿童肱骨近端骨骺分离的临床疗效。方法回顾性分析48例儿童肱骨近端骨骺分离患者的病例资料,按临床手术方式不同分为A组和B组,各24例,其中A组行经皮穿针内固定,B组行闭合复位外固定。随访观察两种方法的治疗效果及并发症。结果所有患者均获随访1年。根据肩肘关节Flynn评分评定疗效,A组肩肘关节功能Flynn评分为(85.35±11.85)分,B组为(74.16±10.12)分,A组Flynn评分高于B组,差异有统计学意义(t=2.585,P=0.029)。根据术前、术后肩关节外展角评定疗效,A组为(171.4±5.4)°,B组为(152.8±6.1)°,两组优良率比较差异有统计学意义(P<0.05)。结论相对闭合复位外固定术,经皮穿针内固定术能明显改善肱骨近端骨骺分离患儿的肩肘外展角,且远期预后更佳,值得临床推广应用。

Objective To compare the clinical outcomes of percutaneous fixation and closed reduction external fixation in the treatment of proximal humerus epiphyseal separation in children. Methods The clinical data of 48 children with fractures of proximal humerus epiphyseal separation were retrospectively analyzed,among whom group A was treated with percutaneous fixation（ n = 24）,and group B was treated with closed reduction and external fixation（ n =24）. The clinical effects and complications were compared between the two groups. Results All the patients were followed up. According to the Flynn score evaluation,the Flynn scores of shoulder and elbow joint function in group A（ 85. 35 ± 11. 85） were significantly higher than those in group B（ 74. 16 ± 10. 12）（ P〈0. 05）. According to the preoperative and postoperative shoulder joint abduction angle evaluations,group A was（ 171. 4 ± 5. 4） degrees,and group B was（ 152. 8 ± 6. 1） degrees,with a significant difference in the excellent and good rate between the two groups（ P〈0. 05）. Conclusion The percutaneous fixation can improve the proximal humerus epiphyseal separation of the shoulder and elbow outreach angle better and has a better long-term prognosis and clinical application than the closed reduction external fixation.