两种固定方法治疗儿童肱骨近端移位骨折的比较

Comparison of two fixations for displaced proximal humeral fracture in children and adolescents

摘要:

［目的］比较两种固定方法治疗儿童肱骨近端移位骨折的临床疗效。［方法］回顾性分析本院 2010 年 8 月—2018 年 5 月接受闭合复位内固定治疗严重移位肱骨近端骨折 71 例患者的临床资料。根据医患沟通结果，将患者分为两组，34 例采用经皮克氏针固定术治疗 （克氏针组），37 例采用逆行弹性髓内钉固定术治疗 （髓内钉组）。比较两组围手术期、随访及影像资料。［结果］两组患者均顺利完成手术，未发生血管、神经损伤等并发症。克氏针组手术时间、切口长度、透视时间均优于髓内钉组，差异均具有统计学意义 （P<0.05）。所有病例术后均获得骨性愈合，无畸形愈合及骺早闭发生。术后 3 个月及末次随访时，两组的肩关节活动范围、DASH 评分和 Constant-Murley 评分差异均无统计学意义 （P>0.05）。影像方面，两组复位质量及骨折愈合时间的差异无统计学意义（P>0.05）。与术前相比，两组术后颈干角均显著增加（P<0.05），相应时间点两组间颈干角的差异无统计学意义（P<0.05）。［结论］闭合复位克氏针或弹性髓内钉都是治疗儿童肱骨近端严重移位骨折的适当方法，临床效果相当。

Abstract:

[Objective] To compare the clinical results of two fixations for displaced proximal humeral fractures in children and adoles- cent. [Methods] A retrospective study was conducted on 71 patients who underwent surgical treatment for remarkably displaced proximal humeral fractures in our hospital between August 2010 and May 2018. According to consequences of preoperative patient-surgeon commu- nication, 34 patients received closed reduction and percutaneous Kirschner wire fixation (the K-wire group) , while the remaining 37 pa- tients had closed reduction and internal fixation with elastic stable intramedullary nail performed (the ESIN group) . The preoperative, fol- low-up and radiographic documentations were analyzed and compared between the two groups. [Results] All patients in both groups had surgical procedures finished smoothly without serious complications, such as neurovascular injury. The K-wire group was significantly su- perior to the ESIN group in terms of operation time and incision length (P＜0.05) . All patients in both groups achieved bony union without malunion and premature epiphyseal closure. At 3 months postoperatively and the latest follow-up, no significant differences were seen be- tween the two groups in terms of forward flexion range of motion (ROM) of the shoulder, Constant-Murley score and Disabilities of the Arm, Shoulder, and Hand Questionnaire (DASH) (P＞0.05) . With respect to radiographic evaluation, there were no significant differences in the fracture reduction quality and fracture healing time between the two groups (P＞0.05) . The humeral neck-shaft angle significantly improved postoperatively compared with that preoperatively in both groups (P＜0.05) , but no a significant difference was noted between the two groups at any matching time point (P＞0.05) . [Conclusions] Both K-wire and ESIN are effective for treating considerably displaced proxi- mal humeral fractures in children and adolescents, with comparable clinical outcomes.