弹性髓内钉固定治疗儿童严重移位肱骨近端骨折的有效性和安全性

Efficacy and safety of elastic intramedullary nail fixation for severe displaced proximal humeral fractures in children

目的探究弹性髓内钉固定治疗儿童严重移位肱骨近端骨折的临床效果及安全性。方法选取2012年12月至2017年12月本院收治的100例严重移位肱骨近端骨折患儿作为研究对象,按照入院时间先后顺序将其分为对照组与观察组,各50例。对照组患儿给予经皮克氏针固定治疗,而观察组患儿行弹性髓内钉固定治疗。比较两组骨折患儿手术情况、临床疗效、肩关节功能评分及并发症发生情况。结果观察组患儿手术时间短于对照组,透视次数少于对照组,差异具有统计学意义(P<0.05);但两组患儿术中出血量及骨折愈合时间比较,差异无统计学意义(P>0.05)。观察组患儿的治疗总有效率为96.00%,高于对照组患儿的80.00%,差异具有统计学意义(P<0.05)。治疗后3、6个月,两组患儿肩关节功能评分比较,差异无统计学意义(P>0.05)。治疗后,观察组患儿针道感染、骨折延迟愈合、退针及皮肤刺激发生率均低于对照组,差异具有统计学意义(P<0.05)。结论经皮克氏针治疗与弹性髓内钉固定治疗儿童严重移位肱骨近端骨折均能够取得一定的治疗效果,但是从整体角度出发,弹性髓内钉固定治疗不仅治疗效果良好,而且术后并发症较少,更值得推荐。

Objective To explore the clinical effect and safety of elastic intramedullary nail fixation for severe displaced proximal humeral fractures in children. Methods A total of 100 children with severe displaced proximal humeral fractures admitted to our hospital from December 2012 to December 2017 were selected as the research objects and divided into control group and observation group according to the time of admission, with 50 cases in each group. The control group was treated with percutaneous Kirschner wire fixation, while the observation group was treated with elastic intramedullary nail fixation. The operation, clinical effect, shoulder function score and complications of the two groups were compared. Results The operation time of the observation group was shorter than that of the control group, and the fluoroscopy times was less than that of the control group, the differences were statistically significant (P <0.05), but there were no significant differences in the amount of intraoperative bleeding and fracture healing time between the two groups (P>0.05). The total effective rate of treatment in the observation group was 96.00%, which was higher than 80.00% of the control group, and the difference was statistically significant (P<0.05). There were no significant differences in shoulder function score at 3 and 6 months after treatment between the two groups (P>0.05). After treatment, the incidences of pin infection, delayed union of fracture, needle withdrawal and skin irritation in the observation group were lower than those in the control group, and the differences were statistically significant (P<0.05). Conclusion Percutaneous Kirschner wire fixation and elastic intramedullary nail fixation for severe displaced proximal humeral fractures in children can achieve certain therapeutic effect. But from the overall point of view, elastic intramedullary nail fixation not only has good therapeutic effect, but also has fewer complications after operation, which is more worthy of recommendation.