3种不同入路弹性髓内针治疗大龄儿童肱骨干骨折临床分析  

Clinical analysis of three different approaches of elastic stable intramedullary nail for treatment of humeral shaft fractures in older children

作　　者：许浩杰 孙祥水 汪飞 江波 侯华成 Xu Haojie Sun Xiangshui Wang Fei Jiang Bo Hou Huacheng(Department of Orthopedics, Children＇s Hospital of Nanfing Medical University, Nanfing 210019, China)

机构地区：[1]南京医科大学附属儿童医院骨科,210019

出　　处：《中华实用儿科临床杂志》2017年第19期1495-1499,共5页Chinese Journal of Applied Clinical Pediatrics

基　　金：南京市医学科技发展基金（YKK14115）

摘　　要：目的比较交叉逆行进针、桡侧逆行进针、顺行进针3种不同入路弹性髓内针治疗大龄儿童肱骨干骨：沂的临床效果。方法回顾性分析2011年1月至2015年12月南京医科大学附属儿童医院使用弹性髓内针治疗的54例大龄儿童肱骨干骨折的临床资料。年龄8～14岁，平均11．4岁；男31例，女23例；左侧24例，右侧30例。根据弹性髓内针进针入路不同，分为交叉逆行组（31例，下称交叉组）、桡侧逆行组（15例，下称桡侧组）和顺行组（8例）。术后采用肩关节外展支具外固定6周。术后3～4个月x线片显示骨折线消失，骨折端有：庄续性骨小梁形成后去除弹性髓内针。对3组患儿手术时间、术后影像学结果、骨折愈合时间、术后近期并发症进行比较分析。结果交叉组术后骨折成角为（5．4±1．8）。，手术时间为（51±25）nlin；桡侧组术后骨折成：角为（12．8±2．9）。，手术时间为（46±12）min；顺行组术后骨折成角为（13．0±3．6）°，手术时间为（44±16）min。交叉组术后骨折断端成角明显小于桡侧组和顺行组，差异有统计学意义（F=19．340，P〈0．01）。患儿随访6～18个月（平均11个月），骨折均顺利愈合。3组术后肩关节Constant评分优良率分别为96．8％（30／31例）、93．3％（14／15例）、87．5％（7／8例），3组术后肘关节Mayo评分优良率分别为93．5％（29／31例）、100．0％（15／15例）、100．0％（8／8例）。随访过程中均未发现骨不连、骨折再移位等并发症发生。交叉组术后出现尺神经麻痹1例；针尾激惹6例，其中1例发生于桡侧组，5例发生于交叉组。结论3种不同入路弹性髓内针治疗大龄儿童肱骨干骨折均取得较好的临床效果。交叉逆行进针术后骨折断端成角最小，最为稳固且适用性广。Objective To discuss the clinical effect of three different approaches of elastic stable intramedullary nail for treatment of humeral shaft fractures in older children. Methods From January 2011 to December 2015,54 older children（31 males and 23 females） aged 8 - 14 years（average 11.4 years old） of humeral shaft fractures were treated in Children＇s Hospital of Nanjing Medical University with elastic stable intramedullary nail. The left side in- volved 24 cases and right involved 30 cases. Patients were divided into 3 groups according to different approaches： bilateral retrograde group （31 cases）, radial retrograde group （ 15 cases） and anterograde group （ 8 cases）. Abduction brace was carried out postoperatively for about 6 weeks. Implant removal took place about 3 -4 months later,when the X -ray showed fracture line disappeared and continuous trabecular bone was formed. A retrospective study was performed to compare the operation time, imaging findings after the surgery, fracture healing time and recent complications among the 3 groups. Results Bilateral retrograde nailing operation lasted for an average of （51 ±25） min and residual angle in X - ray films postoperative was （5.4 ± 1.8）°. The radial retrograde nailing average operating time was（46 ± 12） min and average residual angle in X -ray films postoperative was （12.8 ±2.9）°, while anterograde nailing was （44 ± 16） rain and （ 13.0 ± 3.6）°. The angle of the fracture after operation in the bilateral retrograde group was significantly less than those of the radial retrograde group and the anterograde group, and the difference was statistically significant （ F = 19.340,P 〈 0.01 ）. Children were followed up for 6 to 18 months （ averaged 11 months）. Each fracture was healed successfully. The excellent rates of Constant scores of postoperative shoulder joints 6 months after surgery were 96.8% （30/31 cases） ,93.3% （ 14/15 cases） ,87.5% （7/8 cases）. The excellent rates of Mayo scores of elb

关 键 词：肱骨骨折 内骨折固定术 弹性髓内针 儿童 

分 类 号：R687.3[医药卫生—骨科学]