CAJ | 학술논문

目的比较大龄儿童肱骨近端骨折非手术治疗与手术治疗的临床疗效.方法从2006年1月至2010年12月,采用手法复位经皮克氏针固定方法治疗大龄儿童肱骨近端骨折24例,非手术方法治疗13例.对手术组与非手术组患儿的肩关节功能、放射学检查结果、肩关节活动度及并发症等资料进行回顾性分析.结果非手术组平均随访15.8个月(4～37个月),手术组平均随访17.4个月(5～30个月),末次随访时骨折均获愈合.手术组复位后残留移位及成角优于非手术组,差异有统计学意义(P＜0.05).手术组出现术后并发症4例,其中针道反应3例,克氏针穿出肱骨头关节面1例；非手术组,出现复位后骨折再移位1例.术后3个月,两组肩关节活动度、Neer肩关节功能评分比较,差异无统计学意义.与非手术组相比,手术组复位及固定时间与住院时间较长、住院费用较高、患肩开始功能锻炼时间较早、复位后复查X线次数少,两组比较差异有统计学意义(P＜0.05).结论大龄儿童肱骨近端骨折手术治疗的复位质量较优,非手术治疗创伤小,费用低,住院时间短,但在术后肩关节功能、活动度及美观上两种治疗方法无明显差异,治疗方式的选择应根据患儿的年龄、骨折类型、软组织损伤程度、合并伤等进行综合考虑.
목적 비교대령인동굉골근단골절비수술치료여수술치료적림상료효.방법 종2006년1월지2010년12월,채용수법복위경피극씨침고정방법치료대령인동굉골근단골절24례,비수술방법치료13례.대수술조여비수술조환인적견관절공능、방사학검사결과、견관절활동도급병발증등자료진행회고성분석.결과 비수술조평균수방15.8개월(4～37개월),수술조평균수방17.4개월(5～30개월),말차수방시골절균획유합.수술조복위후잔류이위급성각우우비수술조,차이유통계학의의(P＜0.05).수술조출현술후병발증4례,기중침도반응3례,극씨침천출굉골두관절면1례；비수술조,출현복위후골절재이위1례.술후3개월,량조견관절활동도、Neer견관절공능평분비교,차이무통계학의의.여비수술조상비,수술조복위급고정시간여주원시간교장、주원비용교고、환견개시공능단련시간교조、복위후복사X선차수소,량조비교차이유통계학의의(P＜0.05).결론 대령인동굉골근단골절수술치료적복위질량교우,비수술치료창상소,비용저,주원시간단,단재술후견관절공능、활동도급미관상량충치료방법무명현차이,치료방식적선택응근거환인적년령、골절류형、연조직손상정도、합병상등진행종합고필.
Objective To compare the outcomes of non-operative and operative treatments of proximal humeral fractures in older children.Methods From January 2006 to December 2010,40 cases of proximal humeral fractures in older children were treated.13 of which by non-operative measure and the remaining 24 patients were treated with manipulative reduction and percutaneous pin fixation.At follow-up,the treatment assessment included radiographic evaluation,detailed physical examination,range of shoulder motion,complications and the assessment of overall shoulder function with the Neer score.Results Our patients were followed up for 4 to 37 months with a mean of 15.8 months in the non-operative group,and 5 to 30 months with a mean of 17.4 months in the operative group.Xray films showed all fractures were healed.Operative group had better quality fracture reduction (P＜0.05).There were no significant difference between the two groups with regard to range of shoulder motion and the Neer score.Operative group had longer stays,higher in-patients costs,earlier mobilization and less frequency of radiography than non-operative group (P＜0.05).Conclusions Operative treatment of proximal humeral fractures in older children is better in the quality of fracture reduction.Non-operative treatment has the advantages of minimally invasive,low inpatient cost,short hospital length of stay,but range of shoulder motion and the Neer score are similar in both treatment.Surgical strategy should be made individually based on patients' conditions.