AO钛制弹性髓内钉内固定与切开复位钢板内固定治疗小儿肱骨干中下段骨折的比较研究  

A comparative study of AO titanium elastic stable intramedullary nail internal fixation versus open reduction plate osteosynthesis for the treatment of mid-distal humeral fractures in children

作　　者：黄杨[1] 王昌兴[2] 邹阳[1] 

机构地区：[1]浙江中医药大学,浙江杭州310053 [2]浙江中医药大学附属第二医院,浙江杭州310005

出　　处：《中医正骨》2015年第7期22-26,共5页The Journal of Traditional Chinese Orthopedics and Traumatology

摘　　要：目的：比较 AO 钛制弹性髓内钉内固定与切开复位钢板内固定治疗小儿肱骨干中下段骨折的临床疗效和安全性。方法：回顾性分析47例肱骨中下段骨折患儿的病例资料，其中采用切开复位钢板内固定28例，采用 AO 弹性髓内钉内固定19例。男27例，女20例；年龄6～11岁，中位数8岁；肱骨干中段骨折16例，下段骨折31例；左侧16例，右侧31例；按照肱骨干骨折的 AO分型，A 型15例、B 型23例、C 型9例。比较2组患者术中出血量、手术时间、住院时间、骨折愈合时间，及术后6个月的肩关节活动度、肘关节活动度、美国加州大学（the University of California at Los Angeles，UCLA）肩关节功能评分和 Mayo 肘关节功能评分，并比较2组患者并发症发生情况。结果：AO 弹性髓内钉内固定组术中出血量少于切开复位钢板内固定组[（95．00±33．39）mL，（192．00±48．18）mL，t ＝7．560，P ＝0．000]，其手术时间、骨折愈合时间均短于切开复位钢板内固定组[（55．50±12．79）min，（71．60±16．45）min，t ＝3．585，P ＝0．001；（9．40±3．04）min，（12．80±4．50）min，t ＝2．860，P ＝0．006]；2组患者住院时间比较，差异无统计学意义[（12．60±1．64）min，（12．70±1．92）min，t ＝0．184，P ＝0．855]。术后6个月 AO 弹性髓内钉内固定组肩关节活动度、肘关节活动度均大于切开复位钢板内固定组[153．95°±16．29°，112．68°±20．21°，t ＝7．410，P ＝0．000；132．00°±6．70°，113．18°±6．78°，t ＝9．382，P ＝0．000]，其 UCLA 肩关节功能评分、Mayo 肘关节功能评分均高于切开复位钢板内固定组[（32．26±2．45）分，（26．50±3．10）分，t ＝6．790，P ＝0．000；（96．52±2．95）分，（87．46±3．94）分，t ＝8．520，P ＝0．000]。AO 弹性髓内钉内固定组并发症发生率小于切开复位钢板内固定组（χ2＝4．970，P �Objective：To compare the clinical effects and safety of internal fixation with AO titanium elastic stable intramedullary nail （ESIN）versus open reduction internal fixation（ORIF）with plate for treatment of mid-distal humeral fractures in children.Methods：The medical records of forty-seven children with mid-distal humeral fractures were analyzed retrospectively.Twenty-eight cases were treated with ORIF with plate while 19 cases were treated with ESIN internal fixation.The patients consisted of 27 males and 20 females,and ranged in age from 6 to 11 years（Median =8 yrs）.Sixteen cases suffered from mid humeral fractures and 31 cases suffered from distal humeral frac-tures.The fractures located in left humerus for 16 cases and right humerus for 31 cases.According to the AO classification of humeral shaft fractures,the fractures belonged to type A（15）,type B（23）and type C（9）.The intraoperative blood loss,operative time,hospital stay time, fracture healing time and complications were compared between the 2 groups.The range of motion（ROM）of shoulder joint and elbow joint, UCLA shoulder performance score and Mayo elbow performance score were recorded at 6 months after the surgery and compared between the 2 groups.Results：The intraoperative blood loss was less in ESIN group compared to ORIF group（95.00 ＋/-33.39 vs 192.00 ＋/-48.18 mL, t =7.560,P =0.000）,and the operative time and fracture healing time were shorter in of ESIN group compared to ORIF group（55.50 ＋/-12.79 vs 71.60 ＋/-16.45 min,t =3.585,P =0.001;9.40 ＋/-3.04 vs 12.80 ＋/-4.50 min,t =2.860,P =0.006）.There was no statistical difference in hospital stay between the two groups（12.60 ＋/-1.64 vs 12.70 ＋/-1.92 min,t =0.184,P =0.855）.At 6 months after the surgery,the range of motion of shoulder joint and elbow joint were higher in ESIN group compared to ORIF group （153.95 ＋/-16.29 degrees vs 112.68 ＋/-20.21 degrees,t =7.410,P =0.000;132.00 ＋/-6.70 vs 113.18 ＋/-6.78 degrees,t =9.382,P =0.000）.Both UC

关 键 词：肱骨骨折 儿童 骨折固定术 内 弹性髓内钉 钢板 治疗 临床研究性 

分 类 号：R726.8[医药卫生—儿科]