经皮撬拨辅助闭合复位加克氏针内固定治疗儿童移位型肱骨外科颈骨折的疗效

Closed reduction assisted by percutaneous Kirschner wire warping and internal fixation for displaced humeral surgical neck fracture in children

目的观察和评估经皮撬拨辅助闭合复位加克氏针内固定手术方法治疗经闭合复位难以满意的儿童移位型肱骨外科颈骨折的临床疗效。方法选取2014年2月至2018年1月在湖北省十堰市人民医院创伤骨科住院治疗的病史、影像学诊断符合移位NeerⅡ型肱骨外科颈骨折患儿35例;采用经皮克氏针撬拨复位内固定治疗儿童移位型肱骨外科颈骨折患儿23例,与采用前侧切口开放复位患儿12例进行对比,术后平均随访12.2(3~24)个月。从手术时间,骨折愈合时间及功能评分等方面对比分析其治疗效果。结果所有病例经开放复位或经皮撬拨辅助闭合复位加克氏针内固定手术后,骨折均达到良好愈合,平均骨折愈合时间为6~8周,无骨折畸形愈合或合并血管神经损伤等并发症。但开放复位组涉及手术创伤及出血、骨折愈合时间和肩关节功能较撬拨复位组具有明显劣势[(3.1±1.0)个月比(2.5±1.1)个月,P<0.05];从手术时间上对比具有轻度优势[(54.9±11.3)min比(63.5±5.6)min,P<0.05]。经皮撬拨组肩关节功能恢复更快[(81.1±4.3)分比(73.4±6.7)分,P<0.05],总优良率达85%。结论经皮撬拨复位克氏针内固定对于儿童移位型肱骨外科颈骨折是一种微创、骨折愈合快、具有可重复性的治疗方法。

Objective To observe and evaluate the clinical effect of K-wire internal fixation after closed reduction assisted by percutaneous warping reduction for displaced humeral surgical neck fracture in children, which is unsatisfactory after closed reduction. Methods From February 2014 to January 2018, 35 cases of the children with displaced humeral surgical neck fracture were retrospectively studied in Department of Traumatic Orthopaedics, Shiyan People's Hospital. Twenty-three cases of the children treated by closed reduction assisted by percutaneous Kirschner wire warping reduction and internal fixation were compared with 12 cases of the children by open reduction surgery through anterior incision. The average follow-up time was 12.2 (3- 24) months . The therapeutic effects were compared and analyzed in terms of operation time, fracture healing time and functional score. Results After open reduction or closed reduction assisted by percutaneous warping reduction and internal fixation with Kirschner wire, the fracture healed well. The average healing time of fracture was 6-8 weeks . There were no complications such as malunion of fracture or combined injury of blood vessel and nerve. However, the open reduction group had obvious disadvantage in fracture healing time and shoulder joint function compared with the warping reduction group because of surgical trauma and bleeding [(3.1±1.0)month vs (2.5±1.1)month, P <0.05];while the operation time has slight advantage[(54.9±11.3)min vs (63.5±5.6)min, P <0.05]. The shoulder function recovered faster in the percutaneous warping group[(81.1±4.3)score vs (73.4±6.7)score, P <0.05], and the total excellent and good rate was 85%. Conclusion Closed reduction assisted by percutaneous warping reduction and K-wire internal fixation for displaced humeral surgical neck fracture in children is a minimally invasive, fast healing and reproducible method, which is worthy of clinical application.