中医正骨
中醫正骨
중의정골
THE JOURNAL OF TRADITIONAL CHINESE ORTHOPEDICS AND TRAUMATOLOGY
2015年
7期
22-26
,共5页
肱骨骨折%儿童%骨折固定术,内%弹性髓内钉%钢板%治疗,临床研究性
肱骨骨摺%兒童%骨摺固定術,內%彈性髓內釘%鋼闆%治療,臨床研究性
굉골골절%인동%골절고정술,내%탄성수내정%강판%치료,림상연구성
humeral fractures%child%fracture fixation,internal%elastic intramedullary nails%plates%therapies,investigational
目的：比较 AO 钛制弹性髓内钉内固定与切开复位钢板内固定治疗小儿肱骨干中下段骨折的临床疗效和安全性。方法：回顾性分析47例肱骨中下段骨折患儿的病例资料，其中采用切开复位钢板内固定28例，采用 AO 弹性髓内钉内固定19例。男27例，女20例；年龄6～11岁，中位数8岁；肱骨干中段骨折16例，下段骨折31例；左侧16例，右侧31例；按照肱骨干骨折的 AO分型，A 型15例、B 型23例、C 型9例。比较2组患者术中出血量、手术时间、住院时间、骨折愈合时间，及术后6个月的肩关节活动度、肘关节活动度、美国加州大学（the University of California at Los Angeles，UCLA）肩关节功能评分和 Mayo 肘关节功能评分，并比较2组患者并发症发生情况。结果：AO 弹性髓内钉内固定组术中出血量少于切开复位钢板内固定组[（95．00±33．39）mL，（192．00±48．18）mL，t ＝7．560，P ＝0．000]，其手术时间、骨折愈合时间均短于切开复位钢板内固定组[（55．50±12．79）min，（71．60±16．45）min，t ＝3．585，P ＝0．001；（9．40±3．04）min，（12．80±4．50）min，t ＝2．860，P ＝0．006]；2组患者住院时间比较，差异无统计学意义[（12．60±1．64）min，（12．70±1．92）min，t ＝0．184，P ＝0．855]。术后6个月 AO 弹性髓内钉内固定组肩关节活动度、肘关节活动度均大于切开复位钢板内固定组[153．95°±16．29°，112．68°±20．21°，t ＝7．410，P ＝0．000；132．00°±6．70°，113．18°±6．78°，t ＝9．382，P ＝0．000]，其 UCLA 肩关节功能评分、Mayo 肘关节功能评分均高于切开复位钢板内固定组[（32．26±2．45）分，（26．50±3．10）分，t ＝6．790，P ＝0．000；（96．52±2．95）分，（87．46±3．94）分，t ＝8．520，P ＝0．000]。AO 弹性髓内钉内固定组并发症发生率小于切开复位钢板内固定组（χ2＝4．970，P ＝0．026）。结论：与切开复位钢板内固定相比，采用 AO 钛制弹性髓内钉内固定治疗小儿肱骨干中下段骨折，创伤小、手术时间短、骨折愈合快，肩、肘关节活动度及功能恢复好，可作为临床治疗小儿肱骨干中下段骨折的一种较为理想的选择。但二者住院时间无明显差异。
目的：比較 AO 鈦製彈性髓內釘內固定與切開複位鋼闆內固定治療小兒肱骨榦中下段骨摺的臨床療效和安全性。方法：迴顧性分析47例肱骨中下段骨摺患兒的病例資料，其中採用切開複位鋼闆內固定28例，採用 AO 彈性髓內釘內固定19例。男27例，女20例；年齡6～11歲，中位數8歲；肱骨榦中段骨摺16例，下段骨摺31例；左側16例，右側31例；按照肱骨榦骨摺的 AO分型，A 型15例、B 型23例、C 型9例。比較2組患者術中齣血量、手術時間、住院時間、骨摺愈閤時間，及術後6箇月的肩關節活動度、肘關節活動度、美國加州大學（the University of California at Los Angeles，UCLA）肩關節功能評分和 Mayo 肘關節功能評分，併比較2組患者併髮癥髮生情況。結果：AO 彈性髓內釘內固定組術中齣血量少于切開複位鋼闆內固定組[（95．00±33．39）mL，（192．00±48．18）mL，t ＝7．560，P ＝0．000]，其手術時間、骨摺愈閤時間均短于切開複位鋼闆內固定組[（55．50±12．79）min，（71．60±16．45）min，t ＝3．585，P ＝0．001；（9．40±3．04）min，（12．80±4．50）min，t ＝2．860，P ＝0．006]；2組患者住院時間比較，差異無統計學意義[（12．60±1．64）min，（12．70±1．92）min，t ＝0．184，P ＝0．855]。術後6箇月 AO 彈性髓內釘內固定組肩關節活動度、肘關節活動度均大于切開複位鋼闆內固定組[153．95°±16．29°，112．68°±20．21°，t ＝7．410，P ＝0．000；132．00°±6．70°，113．18°±6．78°，t ＝9．382，P ＝0．000]，其 UCLA 肩關節功能評分、Mayo 肘關節功能評分均高于切開複位鋼闆內固定組[（32．26±2．45）分，（26．50±3．10）分，t ＝6．790，P ＝0．000；（96．52±2．95）分，（87．46±3．94）分，t ＝8．520，P ＝0．000]。AO 彈性髓內釘內固定組併髮癥髮生率小于切開複位鋼闆內固定組（χ2＝4．970，P ＝0．026）。結論：與切開複位鋼闆內固定相比，採用 AO 鈦製彈性髓內釘內固定治療小兒肱骨榦中下段骨摺，創傷小、手術時間短、骨摺愈閤快，肩、肘關節活動度及功能恢複好，可作為臨床治療小兒肱骨榦中下段骨摺的一種較為理想的選擇。但二者住院時間無明顯差異。
목적：비교 AO 태제탄성수내정내고정여절개복위강판내고정치료소인굉골간중하단골절적림상료효화안전성。방법：회고성분석47례굉골중하단골절환인적병례자료，기중채용절개복위강판내고정28례，채용 AO 탄성수내정내고정19례。남27례，녀20례；년령6～11세，중위수8세；굉골간중단골절16례，하단골절31례；좌측16례，우측31례；안조굉골간골절적 AO분형，A 형15례、B 형23례、C 형9례。비교2조환자술중출혈량、수술시간、주원시간、골절유합시간，급술후6개월적견관절활동도、주관절활동도、미국가주대학（the University of California at Los Angeles，UCLA）견관절공능평분화 Mayo 주관절공능평분，병비교2조환자병발증발생정황。결과：AO 탄성수내정내고정조술중출혈량소우절개복위강판내고정조[（95．00±33．39）mL，（192．00±48．18）mL，t ＝7．560，P ＝0．000]，기수술시간、골절유합시간균단우절개복위강판내고정조[（55．50±12．79）min，（71．60±16．45）min，t ＝3．585，P ＝0．001；（9．40±3．04）min，（12．80±4．50）min，t ＝2．860，P ＝0．006]；2조환자주원시간비교，차이무통계학의의[（12．60±1．64）min，（12．70±1．92）min，t ＝0．184，P ＝0．855]。술후6개월 AO 탄성수내정내고정조견관절활동도、주관절활동도균대우절개복위강판내고정조[153．95°±16．29°，112．68°±20．21°，t ＝7．410，P ＝0．000；132．00°±6．70°，113．18°±6．78°，t ＝9．382，P ＝0．000]，기 UCLA 견관절공능평분、Mayo 주관절공능평분균고우절개복위강판내고정조[（32．26±2．45）분，（26．50±3．10）분，t ＝6．790，P ＝0．000；（96．52±2．95）분，（87．46±3．94）분，t ＝8．520，P ＝0．000]。AO 탄성수내정내고정조병발증발생솔소우절개복위강판내고정조（χ2＝4．970，P ＝0．026）。결론：여절개복위강판내고정상비，채용 AO 태제탄성수내정내고정치료소인굉골간중하단골절，창상소、수술시간단、골절유합쾌，견、주관절활동도급공능회복호，가작위림상치료소인굉골간중하단골절적일충교위이상적선택。단이자주원시간무명현차이。
Objective:To compare the clinical effects and safety of internal fixation with AO titanium elastic stable intramedullary nail (ESIN)versus open reduction internal fixation(ORIF)with plate for treatment of mid-distal humeral fractures in children.Methods:The medical records of forty-seven children with mid-distal humeral fractures were analyzed retrospectively.Twenty-eight cases were treated with ORIF with plate while 19 cases were treated with ESIN internal fixation.The patients consisted of 27 males and 20 females,and ranged in age from 6 to 11 years(Median =8 yrs).Sixteen cases suffered from mid humeral fractures and 31 cases suffered from distal humeral frac-tures.The fractures located in left humerus for 16 cases and right humerus for 31 cases.According to the AO classification of humeral shaft fractures,the fractures belonged to type A(15),type B(23)and type C(9).The intraoperative blood loss,operative time,hospital stay time, fracture healing time and complications were compared between the 2 groups.The range of motion(ROM)of shoulder joint and elbow joint, UCLA shoulder performance score and Mayo elbow performance score were recorded at 6 months after the surgery and compared between the 2 groups.Results:The intraoperative blood loss was less in ESIN group compared to ORIF group(95.00 +/-33.39 vs 192.00 +/-48.18 mL, t =7.560,P =0.000),and the operative time and fracture healing time were shorter in of ESIN group compared to ORIF group(55.50 +/-12.79 vs 71.60 +/-16.45 min,t =3.585,P =0.001;9.40 +/-3.04 vs 12.80 +/-4.50 min,t =2.860,P =0.006).There was no statistical difference in hospital stay between the two groups(12.60 +/-1.64 vs 12.70 +/-1.92 min,t =0.184,P =0.855).At 6 months after the surgery,the range of motion of shoulder joint and elbow joint were higher in ESIN group compared to ORIF group (153.95 +/-16.29 degrees vs 112.68 +/-20.21 degrees,t =7.410,P =0.000;132.00 +/-6.70 vs 113.18 +/-6.78 degrees,t =9.382,P =0.000).Both UCLA shoulder performance score and Mayo elbow performance score were higher in ESIN group compared to ORIF group(32.26 +/-2.45 vs 26.50 +/-3.10 points,t =6.790,P =0.000;96.52 +/-2.95 vs 87.46 +/-3.94 points,t =8.520,P =0.000).The incidence rate of complications were lower in ESIN group compared to ORIF group(χ2 =4.970,P =0.026).Conclusion:Compared with open reduction plate internal fixation,AO titanium elastic stable intramedullary nail internal fixation has such advantages as less injury,shorter operative time,shorter fracture healing time and larger range of motion and better performance of shoulder joint and elbow joint,so it can be used as a comparatively ideal method for treatment of mid-distal humeral shaft fractures in children.However,there is no obvious difference in hospital stay between the 2 methods.
