Wei Sheng-Wang, Zhao You-Ming, Yang Jie, Wu Rui-Kai, Lou Yi, Chen Hua, Gup Xiao-Shan
Department of Orthopaedics, the Second Affiliated Hospital of Wenzhou Medical College, Zhejiang, China.
Zhongguo Gu Shang. 2012 Feb;25(2):158-61.
To evaluate the results of manipulative reduction and percutaneous pin fixation for the treatment of severely displaced proximal humeru fracturess in children.
From January 2006 to December 2010, 43 patients with severely displaced proximal humeru fractures were treated with manipulative reduction and percutaneous pin fixation. There were 28 boys and 15 girls,ranging in age from 3 to 17 years,with an average of 11.1 years. Preoperative diagnoses were confirmed by the X-ray films as Neer-Horwitz type III or IV fractures. All the patients were close fractures without nerve or vascular injuries. Under C-arm X-ray machine, anatomical reduction was achieved by manipulative reduction according to the bone fracture type. The fractures were fixed by percutaneous pinning. Postoperative X-ray confirmed anatomical reduction. Follow-up index were recorded: intra-operative and postoperative complications, postoperative radiographic examination, upper extremity length and range of shoulder motion. Neer score system was used to evaluate shoulder function.
All the patients were followed up, and the duration ranged from 3 to 37 months with an average of 20.4 months. The mean Neer score of the injured side was (95.0 +/- 4.3) (ranged, 85 to 100). Thirty-eight patients got an excellent result, 5 good. The X-ray showed all the fractures healed without shortening deformity or epiphyseal arrest at early stage. All the patients could participate in the normal physical activities and had a normal range of motion and excellent strength of the shoulder joint.
The method of manipulative reduction and percutaneous pin fixation is relatively reliable treatment for severely displaced proximal humerus fractures in children.
评估手法复位及经皮穿针固定治疗儿童严重移位的肱骨近端骨折的效果。
2006年1月至2010年12月，43例严重移位的肱骨近端骨折患儿接受手法复位及经皮穿针固定治疗。其中男28例，女15例，年龄3至17岁，平均11.1岁。术前经X线片确诊为Neer-HorwitzⅢ型或Ⅳ型骨折。所有患儿均为闭合性骨折，无神经或血管损伤。在C型臂X线机透视下，根据骨折类型行手法复位以达到解剖复位，然后经皮穿针固定骨折。术后X线证实为解剖复位。记录随访指标：术中及术后并发症、术后影像学检查、上肢长度及肩关节活动范围。采用Neer评分系统评估肩关节功能。
所有患儿均获随访，随访时间3至37个月，平均20.4个月。患侧Neer评分平均为(95.0±4.3)(范围85至100)。优38例，良5例。X线显示所有骨折均早期愈合，无短缩畸形或骨骺阻滞。所有患儿均能参加正常体育活动，肩关节活动范围正常，力量良好。
手法复位及经皮穿针固定治疗儿童严重移位的肱骨近端骨折是一种相对可靠的方法。
