两种方法治疗大龄儿童肱骨外科颈骨折的疗效比较

Comparison of two methods in treatment of surgical neck fracture of humerus in elder children

目的观察大龄儿童移位型肱骨外科颈骨折经闭合复位逆向弹性髓内针内固定以及克氏针内固定两种不同手术方法的临床疗效对比。方法回顾性分析十堰市人民医院创伤骨科从2016年5月至2018年12月2.5年间符合纳入标准的手术内固定治疗的儿童及青少年移位型肱骨外科颈骨折45例患者,按照内固定方法分为两组:逆向弹性髓内针内固定23例(弹性髓内针组);闭合复位克氏针内固定22例(克氏针组)。采用t检验或卡方检验分析骨折愈合时间,肩关节功能评分、并发症个数及优良率。结果所有病例骨折均达到良好愈合,骨折愈合时间为(8.0±2.1)周。术后6周两组功能评分弹性髓内针组优于克氏针组(t=5.295,P<0.05);术后3个月功能评分无明显差异(P>0.05)。88.9%患者肩关节功能均达到了优良效果,两组优良率无明显差异(X^(2)=0,P>0.05)。弹性髓内针组有1例出现桡神经挫伤,2例出现弹性髓内针穿出;4例出现复位再丢失。但克氏针内固定组出现了克氏针松动、脱落4例;骨折复位丢失3例;无血管神经损伤并发症。结论采用逆向弹性髓内针及克氏针内固定治疗儿童移位型肱骨外科颈骨折,都是微创、有效的治疗方法,值得临床推广运用。术者应选择熟悉的手术方法避免并发症。

Objective To observe the clinical effect of closed reduction and retrograde elastic stable intramedullary nailing fixation and bone wire internal fixation for displaced surgical neck fracture of humerus in elder children.Methods Forty-five cases of displaced humeral surgical neck fractures in children and adolescents who met the inclusion criteria from May 2016 to December 2018 in the Renmin Hospital of Hubei Uiversity,were retrospectively analyzed.They were divided into two groups according to different internal fixation methods:the intramedullary nailing group(23 cases)were treated with retrograde elastic stable intramedullary nailing;the Kirschner wire group(22 cases)were treated with closed reduction and Kirschner wire fixation.The t test and chi square test were used to analyze the fracture healing time,shoulder function score,number of complications and excellent and good rate.Results The fracture healing time was(8.0±2.1)weeks.There was stattstically significant difference in the functional score of six weeks after operation(t=5.295,P<0.05);there was no stattstically significant difference in the functional score of three months after the operation(P>0.05).The rate of patients who achieved excellent results in shoulder joint function was 88.9%,while the good rates between the two groups showed no significant statistical difference(χ^(2)=0,P>0.05).In the intramedullary nailing group,one case had radial nerve injury,two cases had elastic stable intramedullary nailing penetration,and four cases lost the reduction.In the group of internal fixation of bone wires,there were four cases of bone wires loosening,three cases of reduction loss,no complication of vascular or nerve injury.Conclusions It is a minimally invasive and effective treatment method to treat the displaced fracture of surgical neck of humerus in children by using etrograde elastic stable intramedullary nailing and bone wires internal fixation,which is worthy of clinical application.Surgeens should choose the familiar operation method to avoid complications.