单根逆行弹性髓内钉技术治疗儿童肱骨近端骨折的短期疗效分析  

Short-term efficacy of single retrograde elastic intramedullary nailing for proximal humerus fractures in children

作　　者：沈阳 孙庆增 李大进 Shen Yang;Sun Qingzeng;Li Dajin(Department of Orthopaedics,Xuzhou Children’s Hospital,Xuzhou Medical University,Xuzhou,Jiangsu Province 22100,China)

机构地区：[1]徐州医科大学附属徐州儿童医院骨科,江苏徐州221000

出　　处：《创伤外科杂志》2025年第3期193-198,共6页Journal of Traumatic Surgery

基　　金：徐州市儿童医院2022年度科研立项项目(22040421)。

摘　　要：目的探讨单根逆行髓内钉技术在儿童肱骨近端骨折中的应用及短期临床疗效。方法回顾性分析2018年6月—2022年1月徐州医科大学附属徐州儿童医院骨科在全麻插管臂丛阻滞下施行闭合复位逆行弹性髓内钉内固定技术的46例肱骨近端骨折患儿临床资料。男34例,女12例;年龄8~16岁,平均13.8岁;左侧23例,右侧23例。根据内固定置钉方式,分为单钉组(20例)和双钉组(26例)。单钉组采用弹性单根髓内钉固定治疗,双钉组采用双根弹性髓内钉固定治疗。比较两组围术期、随访及影像学资料。结果两组均为闭合复位髓内钉内固定,未出现血管、神经损伤等并发症。单钉组和双钉组手术时间分别为(42.15±4.37)min、(66.62±6.27)min,差异有统计学意义(P<0.001);透视次数分别为(12.55±3.32)次、(19.35±4.02)次,差异有统计学意义(P<0.001);手术切口总长度分别为(1.38±0.35)cm、(2.99±0.57)cm,差异有统计学意义(P<0.001)。住院时间分别为(4.35±0.93)d、(4.19±0.90)d,两组差异无统计学意义(P=0.564)。患儿术后均获得骨性愈合,无畸形愈合及骺早闭发生。术后3、6个月门诊随访,两组肩关节Neer评分差异均无统计学意义(P>0.05)。影像学评价结果显示,两组复位质量及骨折愈合时间比较差异无统计学意义(P>0.05)。两组术后并发症发生比较差异无统计学意义(P>0.05)。结论单根逆行弹性髓内钉技术可以成功治疗儿童肱骨近端骨折,机械强度和治疗效果与双根逆行弹性髓内钉相当,同时减少了手术时间。Objective To investigate the application and short-term clinical effect of single retrograde elastic intramedullary nailing in the treatment of proximal humerus fractures in children.Methods Clinical data of 46 patients with proximal humerus fractures(Neer-Horwitz typesⅢandⅣ)treated in our department with closed reduction retrograde elastic intramedullary nail internal fixation from Jun.2018 to Jan.2022 were retrospectively analyzed.There were 34 males and 12 females,with the age range of 8-16 years(mean 13.8 years);23 cases affected the left side and 23 the right side.According to the intramedullary nailing methods,patients were divided into single nailing group(20 cases,13 Neer-Horwitz typeⅢand 7 typeⅣ)and double nailing group(26 cases,16 Neer-Horwitz typeⅢand 10 typeⅣ).The perioperative information,functional recovery and imaging data of the two groups were compared.Results General data,injury types and severity were revealed no significant difference between the two groups(all P>0.05).Closed reduction was completed in both groups without vascular or nerve injuries.The single nailing group showed shorter operation time(min,42.15±4.37 vs.66.62±6.27),fewer times of intraoperative fluoroscopy(12.55±3.32 vs.19.35±4.02)and shorter incision length(cm,1.38±0.35 vs.2.99±0.57),revealing significant differences compared with the double nailing group(all P<0.001);while the length of hospital stay was similar(d,4.35±0.93 vs.4.19±0.90,P=0.564).Bone union was obtained in all patients after surgery without malunion or epiphyseal closure.At 3 and 6 months,follow-up results showed no significant difference in shoulder Neer score or reduction quality and fracture healing time by imaging assessment(all P>0.05).Comparison of the postoperative complications was also insignificant.Conclusion Single retrograde elastic intramedullary nailing can well manage severe proximal humerus fractures as double nailing in children,but the former has the advantages of shorter operation time and less intraoperative fluoroscopy

关 键 词：肱骨近端骨折 单根 逆行弹性髓内钉 儿童 

分 类 号：R726.8[医药卫生—儿科]