经皮克氏针固定治疗严重移位儿童肱骨近端骨折  

Manipulative reduction and percutaneous pin fixation for the treatment of severely displaced proximal humerus fractures in children

作　　者：韦盛旺[1] 赵友明[1] 杨杰[1] 吴瑞凯[1] 楼毅[1] 陈华[1] 郭晓山[1] 

机构地区：[1]温州医学院附属二院骨科,浙江温州325027

出　　处：《中国骨伤》2012年第2期158-161,共4页China Journal of Orthopaedics and Traumatology

摘　　要：目的:评估采用手法复位、经皮克氏针固定方法治疗严重移位儿童肱骨近端骨折的疗效。方法:2006年1月至2010年12月,采用手法复位、经皮克氏针固定治疗儿童肱骨近端骨折43例,男28例,女15例;年龄3～17岁,平均11.1岁。术前经X线片确诊,均为Neer-HorwitzⅢ及Ⅳ型。全部病例均为闭合性骨折,无神经血管损伤表现。手术在C形臂X线机监视下进行,根据骨折类型及移位情况进行手法复位,复位满意后行经皮克氏针固定。记录术中及术后并发症、术后放射学检查结果、上肢长度及肩关节活动度,并以Neer肩关节功能评分标准对肩关节功能进行评分。结果:全部病例获随访,时间3～37个月,平均20.4个月。术后出现克氏针穿出关节面1例,针道反应5例,末次随访时肩关节功能Neer评分为85～100分,平均(95.0±4.3)分;优38例,满意5例。X线片显示所有病例骨性愈合,未发现骨骺早闭现象,无肢体短缩畸形。术后3个月,所有患儿能参加正常的体育活动,肩关节活动恢复至伤前。结论:采用手法复位、经皮克氏针固定方法治疗严重移位的儿童肱骨近端骨折,手术操作简单,疗效满意。Objective：To evaluate the results of manipulative reduction and percutaneous pin fixation for the treatment of severely displaced proximal humeru fracturess in children. Methods：From January 2006 to December 2010,43 patients with severely displaced proximal humeru fractures were treated with manipulative reduction and percutaneous pin fixation. There were 28 boys and 15 girls,ranging in age from 3 to 17 years,with an average of 11.1 years. Preoperative diagnoses were confirmed by the X-ray films as Neer-Horwitz type Ⅲ or Ⅳ fractures. All the patients were close fractures without nerve or vascular injuries. Under C-arm X-ray machine,anatomical reduction was achieved by manipulative reduction according to the bone fracture type. The fractures were fixed by percutaneous pinning. Postoperative X-ray confirmed anatomical reduction. Follow-up index were recorded：intra-operative and postoperative complications,postoperative radiographic examination,upper extremity length and range of shoulder motion. Neer score system was used to evaluate shoulder function. Results：All the patients were followed up,and the duration ranged from 3 to 37 months with an average of 20.4 months. The mean Neer score of the injured side was （95.0±4.3） （ranged,85 to 100）. Thirty-eight patients got an excellent result,5 good. The X-ray showed all the fractures healed without shortening deformity or epiphyseal arrest at early stage. All the patients could participate in the normal physical activities and had a normal range of motion and excellent strength of the shoulder joint. Conclusion：The method of manipulative reduction and percutaneous pin fixation is relatively reliable treatment for severely displaced proximal humerus fractures in children.

关 键 词：肱骨骨折 儿童 骨折固定术 内 随访研究 

分 类 号：R683.42[医药卫生—骨科学]