传统正骨手法复位经皮弹性髓内钉固定治疗儿童肱骨近端骨折  

Traditional manipulative reduction and percutaneous elastic intramedullary nail fixation for the treatment of proximal humeral fractures in children

作　　者：王俊义[1] 王巧迪 

机构地区：[1]简阳市第二人民医院,四川简阳641421 [2]西南医科大学,四川泸州646000

出　　处：《中国骨伤》2017年第11期1063-1066,共4页China Journal of Orthopaedics and Traumatology

摘　　要：目的 :探讨儿童肱骨近端骨折采用传统正骨手法复位经皮弹性髓内钉固定治疗的临床疗效和安全性。方法:回顾2012年10月至2016年5月,运用传统正骨手法复位弹性髓内钉经皮内固定治疗65例,其中男52例,女13例;年龄7~14岁,平均11.2岁;左侧23例,右侧42例;斜形骨折13例,横形骨折49例,粉碎性骨折3例。全部为闭合性明显移位性骨折,不合并血管、神经损伤。就诊时间为伤后20 min^5 d,平均3 d。术后随访观察骨折愈合及并发症的发生情况,并运用Neer肩关节功能评分法评价疗效。结果:手术时间30~40 min,平均35 min;术中出血5~10 ml,平均6.5 ml。65例均获随访,时间12~28个月,平均18个月,骨折全部愈合。按照Neer肩关节功能评分法评价疗效,优59例,良5例,可1例。4例针尾部皮肤少许分泌物,2例皮肤激惹现象,1例部分退针,均在取针后愈合。无断钉及退钉现象造成的骨不愈合现象发生,无血管、神经损伤病例发生。结论:手法复位经皮弹性髓内钉固定治疗儿童肱骨近端骨折的方法,具有创伤小、恢复快、并发症少、操作方法简单等优点。Objective：To study clinical effects and safety of traditional manipulative reduction and percutaneous elastic intramedullary nail fixation for the treatment of proximal humeral fractures in children. Methods：From October 2012 to May2016,65 patients with proximal humeral fractures were treated with traditional manipulative reduction and percutaneous elastic intramedullary nail fixation. There were 52 boys and 13 girls,ranging in age from 7 to 14 years old,with an average age of 11.2 years old. Twenty three patients had injuries on the left side,and 42 patients had injuries on the right side. There were 13 cases of oblique fracture,49 cases of transverse fracture,and 3 cases of comminuted fracture. All the patients had closed,obviously displaced fractures,without vascular and nerve injuries. The duration from injury to treatment ranged from 20 minutes to 5 days,with a mean of 3 days. The fracture healing and complications were observed after operation,and the curative effect was evaluated by Neer shoulder function score. Results：The operation time ranged from 30 to 40 minutes,with a mean of 35 minutes;intraoperative blood loss ranged from 5 to 10 ml,with a mean of 6.5 ml. All the patients were followed up,and the duration ranged from 12 to 28 months,with an average of 18 months. All the fractures healed. According to the Neer evaluation system,59 patients got an excellent result,5 good and 1 fair. Four patients had a small amount of secretions on the tail of the needle; 2 patients had skin irritation; 1 patient had partial withdrawal of the nail,and the skin in all the patients healed after taking out the nail. No patients had nonunion fractures due to the broken nails and loosen screws,and no vascular or nerve injuries occurred. Conclusion：Traditional manipulative reduction and percutaneous elastic intramedullary nail fixation for the treatment of proximal humeral fractures in children has the advantages of less trauma,quicker recovery,less complications and simple operation.

关 键 词：肱骨骨折 骨折固定术 髓内 手法 骨科 

分 类 号：R683.41[医药卫生—骨科学]