闭合复位弹性髓内钉内固定联合外固定架固定治疗大龄儿童移位肱骨干骨折疗效分析

Efficacy analysis of closed reduction and intramedullary elastic nail fixation combined with external fixator in treatment of displaced humerus shaft fractures in older children

目的比较闭合复位弹性髓内钉内固定联合外固定架固定与切开复位钢板内固定治疗大龄儿童移位肱骨干骨折的临床疗效。方法回顾性分析自2016-07—2023-05手术治疗的42例大龄儿童移位肱骨干骨折,观察组26例行闭合复位弹性髓内钉内固定联合外固定架固定,对照组16例行切开复位钢板内固定。比较两组手术时间、术中出血量、切口瘢痕长度、骨折愈合时间、并发症发生率,以及末次随访肩关节功能Neer评分、肘关节功能Mayo评分。结果42例均获得随访,随访时间为6~12个月,平均9.6个月。观察组手术时间较对照组短,术中出血量较对照组少,切口瘢痕长度较对照组短,差异有统计学意义(P<0.05)。观察组术后1例切口感染,并发症发生率为3.8%。对照组术后2例切口感染,1例桡神经损伤,1例再骨折,并发症发生率为25%。观察组术后并发症发生率明显低于对照组,差异有统计学意义(P<0.05)。观察组与对照组骨折愈合时间、末次随访时肩关节功能Neer评分和肘关节功能Mayo评分差异无统计学意义(P>0.05)。结论闭合复位弹性髓内钉内固定联合外固定架固定是大龄儿童移位肱骨干骨折有效的手术治疗方法,具有手术创伤小、骨折固定可靠、术后并发症发生率低、术后康复快等优点。

Objective To compare the clinical efficacy of closed reduction and intramedullary elastic nail fixation combined with external fixator versus open reduction and internal plate fixation in the treatment of displaced humerus shaft fractures in older children.Methods A retrospective analysis was conducted on 42 cases of displaced diaphyseal humerus fractures in older children who underwent surgical treatment from July 2016 to May 2023.The observation group,consisting of 26 cases,received closed reduction and intramedullary elastic nail fixation combined with external fixator,while the control group,consisting of 16 cases,received open reduction and plate fixation.The two groups were compared in terms of surgery duration,intraoperative blood loss,incision scar length,fracture healing time,complication rates,and shoulder joint function(Neer score)and elbow joint function(Mayo score)at the final follow-up.Results All 42 cases were followed up for 6 to 12 months,with an average follow-up duration of 9.6 months.The observation group had a shorter surgery duration,less intraoperative blood loss,and shorter incision scar length compared to the control group,with statistically significant differences(P<0.05).In the observation group,there was one case of postoperative wound infection,resulting in a complication rate of 3.8%.In the control group,there were two cases of postoperative wound infection,including one case of radial nerve injury,and one case of refracture,resulting in a complication rate of 25%.The complication rate in the observation group was significantly lower than that in the control group(P<0.05).There were no statistically significant differences between the observation and control groups in terms of fracture healing time,shoulder joint function(Neer score),and elbow joint function(Mayo score)at the final follow-up(P>0.05).Conclusion Closed reduction and intramedullary elastic nail fixation combined with external fixator is an effective surgical treatment for displaced humerus shaft fractures in older children.This approach offers advantages such as minimal surgical trauma,reliable fracture fixation,a low incidence of postoperative complications,and rapid postoperative recovery.