中华小儿外科杂志
中華小兒外科雜誌
중화소인외과잡지
CHINESE JOURNAL OF PEDIATRIC SURGERY
2014年
1期
6-10
,共5页
孙祥水%楼跃%范毓华%唐凯%张志群%林刚%倪磊%刘飞%江波
孫祥水%樓躍%範毓華%唐凱%張誌群%林剛%倪磊%劉飛%江波
손상수%루약%범육화%당개%장지군%림강%예뢰%류비%강파
肱骨骨折%骨折固定术,内%切开复位
肱骨骨摺%骨摺固定術,內%切開複位
굉골골절%골절고정술,내%절개복위
Humerus fractures%Fracture fixation,internal%Open reduction
目的 比较克氏针(K-wires)、接骨板(Plate)、弹性髓内针(elastic stable intramedullarvnailing,ESIN)技术治疗大龄儿童肱骨近端骨折的临床疗效.方法 回顾性分析2006年6月至2012年12月我科收治且获得随访的84例大龄儿童肱骨近端骨折手术患儿的临床资料.根据内固定方式不同,分为切开复位克氏针固定组(32例)、切开复位接骨板内固定组(16例)及弹性髓内针逆行髓内内固定组(36例).年龄8～14岁,平均年龄1t.6岁.男48例,女36例.左侧31例,右侧53例.对三组患儿手术时间、术中出血量、手术切口瘢痕长度、术后住院时间、术后的影像学结果、骨折愈合时间、术后并发症及肩关节Constant评分进行比较.结果 所有患儿术后均获8～24个月(平均13个月)随访.K-wires、Plate、ESIN组的手术时间分别为(72±10)、(82±14)和(48±8)min,术中出血量分别为(50±6)、(64±7)和(25±6)ml,手术切口瘢痕长度分别为(6.2±1.9)、(8.2±2.8)和(4.0±2.1)cm,骨折临床愈合时间分别为(8.8±0.7)、(9.2±0.9)和(8.2±0.8)周,术后发生并发症比例分别为2/32、0/16和2/36,术后6个月肩关节Constant评分优良率分别为90.7％ (29/32)、93.7％(15/16)、和94.4％ (34/36).弹性髓内针髓内逆行内固定组患儿在手术时间、术中出血量、手术切口瘢痕长度明显优于切开复位克氏针组及切开复位接骨板内固定组(P＜0.05).而三组患儿在术后住院时间、骨折愈合时间、术后影像学结果及肩关节Constant评分比较均无统计学意义(P＞0.05).三组病例均未发生骨不愈合及肱骨头坏死.结论 三种内固定方式治疗大龄儿童肱骨近端骨折在术后肩关节功能评估、骨折愈合时间及术后影像学结果上无显著差异.从手术时间、手术瘢痕、术中出血量等方面进行综合比较,弹性髓内针组优于克氏针及接骨板组,具有微创,术中出血少,手术时间短,手术瘢痕小等优点,是临床治疗大龄儿童肱骨近端骨折优先的治疗选择.
目的 比較剋氏針(K-wires)、接骨闆(Plate)、彈性髓內針(elastic stable intramedullarvnailing,ESIN)技術治療大齡兒童肱骨近耑骨摺的臨床療效.方法 迴顧性分析2006年6月至2012年12月我科收治且穫得隨訪的84例大齡兒童肱骨近耑骨摺手術患兒的臨床資料.根據內固定方式不同,分為切開複位剋氏針固定組(32例)、切開複位接骨闆內固定組(16例)及彈性髓內針逆行髓內內固定組(36例).年齡8～14歲,平均年齡1t.6歲.男48例,女36例.左側31例,右側53例.對三組患兒手術時間、術中齣血量、手術切口瘢痕長度、術後住院時間、術後的影像學結果、骨摺愈閤時間、術後併髮癥及肩關節Constant評分進行比較.結果 所有患兒術後均穫8～24箇月(平均13箇月)隨訪.K-wires、Plate、ESIN組的手術時間分彆為(72±10)、(82±14)和(48±8)min,術中齣血量分彆為(50±6)、(64±7)和(25±6)ml,手術切口瘢痕長度分彆為(6.2±1.9)、(8.2±2.8)和(4.0±2.1)cm,骨摺臨床愈閤時間分彆為(8.8±0.7)、(9.2±0.9)和(8.2±0.8)週,術後髮生併髮癥比例分彆為2/32、0/16和2/36,術後6箇月肩關節Constant評分優良率分彆為90.7％ (29/32)、93.7％(15/16)、和94.4％ (34/36).彈性髓內針髓內逆行內固定組患兒在手術時間、術中齣血量、手術切口瘢痕長度明顯優于切開複位剋氏針組及切開複位接骨闆內固定組(P＜0.05).而三組患兒在術後住院時間、骨摺愈閤時間、術後影像學結果及肩關節Constant評分比較均無統計學意義(P＞0.05).三組病例均未髮生骨不愈閤及肱骨頭壞死.結論 三種內固定方式治療大齡兒童肱骨近耑骨摺在術後肩關節功能評估、骨摺愈閤時間及術後影像學結果上無顯著差異.從手術時間、手術瘢痕、術中齣血量等方麵進行綜閤比較,彈性髓內針組優于剋氏針及接骨闆組,具有微創,術中齣血少,手術時間短,手術瘢痕小等優點,是臨床治療大齡兒童肱骨近耑骨摺優先的治療選擇.
목적 비교극씨침(K-wires)、접골판(Plate)、탄성수내침(elastic stable intramedullarvnailing,ESIN)기술치료대령인동굉골근단골절적림상료효.방법 회고성분석2006년6월지2012년12월아과수치차획득수방적84례대령인동굉골근단골절수술환인적림상자료.근거내고정방식불동,분위절개복위극씨침고정조(32례)、절개복위접골판내고정조(16례)급탄성수내침역행수내내고정조(36례).년령8～14세,평균년령1t.6세.남48례,녀36례.좌측31례,우측53례.대삼조환인수술시간、술중출혈량、수술절구반흔장도、술후주원시간、술후적영상학결과、골절유합시간、술후병발증급견관절Constant평분진행비교.결과 소유환인술후균획8～24개월(평균13개월)수방.K-wires、Plate、ESIN조적수술시간분별위(72±10)、(82±14)화(48±8)min,술중출혈량분별위(50±6)、(64±7)화(25±6)ml,수술절구반흔장도분별위(6.2±1.9)、(8.2±2.8)화(4.0±2.1)cm,골절림상유합시간분별위(8.8±0.7)、(9.2±0.9)화(8.2±0.8)주,술후발생병발증비례분별위2/32、0/16화2/36,술후6개월견관절Constant평분우량솔분별위90.7％ (29/32)、93.7％(15/16)、화94.4％ (34/36).탄성수내침수내역행내고정조환인재수술시간、술중출혈량、수술절구반흔장도명현우우절개복위극씨침조급절개복위접골판내고정조(P＜0.05).이삼조환인재술후주원시간、골절유합시간、술후영상학결과급견관절Constant평분비교균무통계학의의(P＞0.05).삼조병례균미발생골불유합급굉골두배사.결론 삼충내고정방식치료대령인동굉골근단골절재술후견관절공능평고、골절유합시간급술후영상학결과상무현저차이.종수술시간、수술반흔、술중출혈량등방면진행종합비교,탄성수내침조우우극씨침급접골판조,구유미창,술중출혈소,수술시간단,수술반흔소등우점,시림상치료대령인동굉골근단골절우선적치료선택.
Objective To compare three internal fixation methods for the treatment of acute proximal humeral fractures in elderly children.Methods From June 2006 to December 2012,84 elderly children treated in our department for acute proximal humeral fractures were retrospectively reviewed.K-wires were used in 32 patients,Plate fixation in 16 patients,and retrograde elastic stable intramedullary nailing technique in 36 patients.There were 48 males and 36 females with an average age of 11.6 (8～14) years.The left side was involved in 31 cases and right in 53.The data of operative time,intra-operative blood loss,wound length,hospital stay,time for union,complication rates,and Constant score of the shoulder were recorded in the three groups and compared statistically.Results The mean follow-up was 13 months (range,8～24 months).The operative time was (72 ± 10),(82± 14) and (48 ± 8)min,the volume of bleeding was (50 ± 6),(64 ± 7) and (25 ± 6)ml,the wound length was (6.2 ± 1.9),(8.2 ± 2.8) and (4.0 ± 2.1)cm,the clinical fracture healing time was (8.8 ± 0.7),(9.2 ± 0.9),and (8.2 ± 0.8) weeks,and the postoperative complication rates were 2/32,0/16,and 2/36,the Constant scores of good and excellent 6 months after surgery were 90.7％ (29/32),93.7％ (15/16),and94.4％ (34/36),in K-wires,Plate,and ESIN groups,respectively.The operative time,intra-operative blood loss,and incision size in retrograde ESIN technique group were significantly prior to those in the other two groups(P＜0.05).However,the time for union,length of hospital stay postoperatively,and the Constant score were not significantly different among the three groups (P＞ 0.05).Conclusions The functional outcomes are similar in older children (older than 8) with acute proximal humeral fractures treated by K-wire,Plate,or ESIN techniques.The retrograde ESIN technique has the advantages of less operative invasion,shorter operative time,less intra-operative blood loss,shorter incision size,and satisfactory shoulder functional recovery.Therefore,for fresh proximal humeral fractures,retrograde ESIN technique is more effective and should be a priority selection.
