闭合复位弹性髓内针治疗大龄儿童锁骨骨折

The Study on the Effect of Closed Reduction and Elastic Intramedullary Nailing on Clavicle Fracture in Children

目的:观察闭合复位弹性髓内针固定治疗大龄儿童完全性锁骨骨折的疗效及安全性。方法:对2017年12月至2019年12月入院的30例大龄儿童锁骨骨折患者采用经皮钳夹端提回旋手法闭合复位、弹性髓内针固定的方法治疗,术后随访6~8个月。结果:30例患者均闭合复位成功,其中27例达到或接近解剖复位,术中出血约10~15mL,手术时间25~60min,平均45min。术后切口均无感染,骨折最快术后4周愈合,最慢术后10周愈合,平均7周愈合,无血管、神经损伤,无断针、退针、弯针和骨折再移位发生,肩关节及肘关节功能均恢复正常,全部病例均在门诊局部麻醉下拔除弹性髓内针,拔针后随访期内均未发生二次骨折。结论:闭合复位弹性髓内针固定治疗大龄儿童完全性锁骨骨折具有创伤小、固定相对可靠、骨折愈合快、内固定物取出相对简单、不易出现二次骨折等优点,安全性高,并发症少,可作为保守治疗和切开复位内固定术的替代治疗方案。

Objective:To observe the efficacy and safety of closed reduction elastic intramedullary nailing fixation in the treatment of complete clavicle fracture in children.Methods:30children with clavicle fractures admitted from December 2017to December 2019were treated with closed reduction and elastic intramedullary nailing fixation by percutaneous clamp end lifting and circumflex manipulation.All patients were followed up for 6to 8months.Results:All 30patients underwent closed reduction,and 27patients achieved or approached anatomic reduction.Intraoperative bleeding was about 10to 15mL,operation time was 25to 60min(45min on average).There was no infections in the incision.The fracture healed in 4weeks and 10weeks after the slowest(7weeks on average).There was no vascular or nerve injury,no broken needles,receding needle,curved needle and fracture re-shifting occurred.The function of shoulder and elbow joint returned to normal,all cases were removed elastic intramedullary nailing under local anesthesia in outpatient clinic,and no secondary fracture occurred during the follow-up period after pulling needle.Conclusion:Closed reduction elastic intramedullary nailing fixation for the treatment of complete clavicle fractures in children has the advantages of small trauma,relatively reliable fixation,fast fracture healing,relatively simple removal of internal fixation,and the difficulty of secondary fractures.With high safety and few complications,it can be used as an alternative treatment for conservative treatment and open reduction and internal fixation.