经皮穿针与弹性髓内钉固定治疗青少年肱骨近端骨折的疗效比较  

Percutaneous pinning versus elastic stable intramedullary nailing for displaced proximal humeral fractures in adolescents

作　　者：孙晋客[1] 刘晓静[1] 王年芳[1] 姜永广[1] 

机构地区：[1]山东省文登整骨医院骨伤研究所,山东威海264400

出　　处：《中华临床医师杂志（电子版）》2014年第6期15-18,共4页Chinese Journal of Clinicians(Electronic Edition)

摘　　要：目的比较经皮穿针与弹性钉髓内固定治疗青少年肱骨近端骨折的临床疗效及安全性。方法对我院2006年5月至2013年6月采用钛制弹性钉髓内固定(TEN组)或经皮穿针固定(PP组)治疗并获得随访的113例青少年肱骨近端骨折患者的临床资料进行回顾性分析。其中采用钛制弹性钉髓内固定65例,经皮穿针固定48例。比较两组患者的手术资料、影像学结果、临床疗效及并发症情况。结果 TEN组患者手术时间(33.1±6.3)min、透视(8.2±2.7)次、骨折愈合时间(6.2±1.2)周;PP组患者手术时间(36.3±8.2)min、透视(11.6±4.1)次、骨折愈合时间(6.1±1.1)周。TEN组透视次数少于PP组,差异有统计学意义(t=2.198,P=0.029);两组患者手术时间、骨折愈合时间差异无统计学意义(t=1.418、0.527,P=0.230、0.668)。TEN组与PP组术后6周随访时Constant-Murley评分分别为(90.4±9.6)、(81.8±9.3)分,差异有统计学意义(t=3.016,P=0.003)。两组患者术后3个月Constant-Murley评分分别为(95.9±5.1)、(96.3±4.8)分,差异无统计学意义(t=0.364,P=0.815)。末次随访时,两组Neer-Horwitz分型及最大成角差异无统计学意义(χ2=0.372,P=0.830;t=0.672,P=0.504)。PP组总体并发症发生率高于TEN组,差异有统计学意义(χ2=21.660,P=0.000)。结论 TEN与PP固定均是治疗青少年肱骨近端骨折的有效方法。与PP相比,TEN固定具有透视次数少,功能恢复早,并发症少等优点。应对术者的经验以及患者的因素等综合考虑,选择合适的固定方式。Objective To compare the clinical results and safety of titanium elastic nails （TEN） and percutaneous pinning （PP） for displaced proximal humeral fractures in adolescents, retrospectively. Methods From May 2006 to June 2013, 113 adolescent patients with displaced proximal humeral fractures were treated with TEN （TEN group） or PP fixation （PP group） and followed up postoperatively in our hospital. Sixty-five cases underwent TEN fixation and 48 cases underwent PP fixation. We compared the clinical results of the 2 groups in terms of general condition, postoperative complications, radiographic results, and Constant-Murley scores at 6 weeks and 3 months postoperatively. Results The operative time, fluoroscopy times and fracture healing time were （33.1±6.3）min, （8.2±2.7） times, and （6.2±1.2） weeks in the TEN group, and （36.3±8.2）min, （11.6±4.1） times, （6.1±1.1） weeks in the PP group, respectively. There was significant difference in fluoroscopy times between the two groups （t=2.198,P=0.029）, while no significant differences were found in the operative time and fracture healing time （t=1.418 and 0.527, P=0.230 and 0.668）. There was significant difference in the Constant-Murley scores at 6 weeks postoperatively between the two groups （90.4±9.6 vs. 81.8±9.3, t=3.016, P=0.003）, while no significant difference was found at 3 months postoperatively （95.9±5.1 vs. 96.3±4.8, t=0.364, P=0.815）. There were no significant differences in Neer-Horwitz classification and angulation between the two groups （χ2=0.372, P=0.830 and t=0.672, P=0.504） at the final follow-up. There were significantly more complications occurred in the PP group than the TEN group （χ2=21.660,P=0.000）. Conclusion The TEN and PP are effective for displaced proximal humeral fractures in adolescents. Compared with PP fixation, the TEN fixation can lead to fewer fluoroscopy times, more rapid functional recovery, and fewer complications.

关 键 词：肱骨骨折 青少年 骨折固定术 内 弹性髓内钉 

分 类 号：R687.3[医药卫生—骨科学]