经皮微创弹性髓内钉治疗儿童锁骨中段骨折临床疗效分析

Therapeutic effects of elastic stable intramedullary nail for the treatment of clavicular fractures in children

(1)目的探讨经皮微创弹性髓内钉固定治疗儿童锁骨中段骨折的临床应用及近期疗效。(2)方法 2014年5月~2017年12月,应用弹性髓内钉治疗18例儿童锁骨中段骨折,男13例,女5例;年龄8~16岁,平均12.6岁;左侧7例,右侧11例。骨折类型:均为闭合性骨折,横行骨折13例,斜形骨折5例(不含长斜形),比较术前与术后3个月的肩关节功能Constant评分,并依据X线片标准、外观情况及功能恢复行疗效评定骨折恢复效果。(3)结果所有患儿术后均获得随访,随访时间3~9个月,平均6.5个月,术后4例出现皮肤激惹现象,无切口感染、弹性髓内钉松动及断裂,术后3个月的Constant评分与术前比较,差异有统计学意义(P<0.01),末次随访按照X线片显示优良率为94.4%;术后14~20周X线片显示骨折愈合后取出弹性髓内钉,肩关节功能恢复良好。(4)结论弹性髓内钉治疗儿童锁骨中段骨折创伤小、固定可靠、功能恢复快、并发症少等,为儿童锁骨中段骨折提供了一种可靠的治疗方法。

Objective To explore the clinical application and recent curative effect of percutaneous minimally invasive elastic stable intramedullary nail for the treatment of clavicular fractures in children.Methods From May 2014 to December 2017,the application of elastic intramedullary nail treatment,18 cases of children re-setting（13 male and 5 female cases）,aged 8 to 16 years old,average 12.6 years,on the left side of 7 cases,11 cases on the right side of the fracture types：closed fractures,transverse fractures in 13 cases,5 cases of oblique fracture（excluding long oblique）,compared the preoperative and postoperative march constant score of shoulder joint function,and on the basis of X ray film standard,exterior condition and effect of curative effect evaluation of fracture restore functional recovery.Results All patients postoperative follow-up,follow-up time from three to nine months,an average of 6.5 months,4 cases with postoperative irritability skin,no incision infection,elastic screw loosening and fracture,compared with preoperative.Constant score at 3 months was statistically significant（P 〈0.01）,according to the last follow-up X-ray showed fine rate was 94.4%;About 14 weeks to 20 weeks after the operation,the X-ray showed that after the fracture healed,the elastic intramedullary nail was taken out and the function of shoulder joint recovered well.Conclusion Minimally invasive elastic stable intramedullary nail for the treatment of clavicular fractures in children.The kind of treatment has small wound,fixed reliability,quick function recovery,few complications,and provides a reliable treatment for children clavicular fractures.