三种弹性髓内针固定技术在治疗儿童肱骨干骨折上的应用  

Application of three insertion techniques of elastic stable intramedullary nail in the treatment of pediatric humeral diaphyseal fractures

作　　者：张骥[1] 冯超[1] 闫桂森[1] 

机构地区：[1]北京积水潭医院小儿骨科,100035

出　　处：《中华小儿外科杂志》2014年第10期731-736,共6页Chinese Journal of Pediatric Surgery

摘　　要：目的探讨采用弹性髓内针（elastic stable intramedullary nail，ESIN）技术治疗儿童肱骨干骨折的手术适应证、固定方式的选择、治疗效果及并发症的处理。方法本文总结2004年至2012年在积水潭医院小儿骨科采用ESIN技术治疗儿童肱骨干骨折的所有病例。资料完整并完成随访的共57例。患儿年龄2岁～14岁5个月，术后平均随访时间1年5个月。其中肱骨干上1／3骨折10例，中1／3骨折29例，下1／3骨折18例。手术适应证包括：不稳定型骨折，保守治疗失败，开放骨折或合并多发创伤等。采取顺行进针技术5例，桡侧逆行进针技术21例，交叉逆行进针技术31例。结果对于肱骨干中1／3和下1／3骨折，交叉逆行进针技术可获得并维持稳定的骨折复位；而采用桡侧逆行进针，有2例出现对线不良。顺行进针治疗下1／3骨折，3例出现对位不良，术后仍需外固定辅助。所有骨折均顺利愈合。患儿术后外观无畸形，功能不受限。9例患儿出现皮肤激惹，其中针尾外露3例。未出现伤口感染、神经血管损伤和骨折再移位等并发症。结论ESIN技术是治疗儿童肱骨干骨折的一种可选方法。交叉逆行进针技术操作安全简单，固定效果可靠。Objective To discuss the indications, surgical techniques, efficacies and complications in the treatment of pediatric humeral diaphyseal fractures with elastic stable intramedullary nail （ESIN）. Methods A retrospective study was conducted for all pediatric humeral diaphyseal fractures with ESIN treated at our hospital between 2004 and 2012. The complete clinic data were collected from 57 patients aged 24-173 months. The mean follow-up period was 17 months. The humeral fracture sites were proximal third （n = 10）, middle third （n = 29） and distal third （n = 18）. The surgical indications included unstable fractures, failure after conservative treatment, open fractures or associated multiple injures. And the manners of surgical techniques were antegrade （n = 5）, radial retrograde （n = 21） and bilateral retrograde （n = 31）. Results Bilateral retrograde manner could provide the stability for middle and distal thirds of humeral shaft fractures. Two cases of radial retrograde manner had angular displacement while 3 cases of antegrade manner translational displacement for distal third. And external immobilization should be combined. All fractures united without abnormal appearance or decreased range of motion. Among 9 patients with skin irritation, three of whom developed nail protrusion through skin. There was no occurrence of infection, neurovascular injury or secondary fracture displacement. Conclusions ESIN provides an option for stabilizing pediatric humeral diaphyseal fractures. The technique of bilateral retrograde insertion is secure, simple and effective.

关 键 词：肱骨骨折 骨折固定术 弹性髓内针 

分 类 号：R726.8[医药卫生—儿科]