Wang Jun-Yi, Wang Qiao-di
The Second People's Hospital, Jianyang 641421, Sichuan, China;
Zhongguo Gu Shang. 2017 Nov 25;30(11):1063-1066. doi: 10.3969/j.issn.1003-0034.2017.11.020.
To study clinical effects and safety of traditional manipulative reduction and percutaneous elastic intramedullary nail fixation for the treatment of proximal humeral fractures in children.
From October 2012 to May 2016, 65 patients with proximal humeral fractures were treated with traditional manipulative reduction and percutaneous elastic intramedullary nail fixation. There were 52 boys and 13 girls, ranging in age from 7 to 14 years old, with an average age of 11.2 years old. Twenty-three patients had injuries on the left side, and 42 patients had injuries on the right side. There were 13 cases of oblique fracture, 49 cases of transverse fracture, and 3 cases of comminuted fracture. All the patients had closed, obviously displaced fractures, without vascular and nerve injuries. The duration from injury to treatment ranged from 20 minutes to 5 days, with a mean of 3 days. The fracture healing and complications were observed after operation, and the curative effect was evaluated by Neer shoulder function score.
The operation time ranged from 30 to 40 minutes, with a mean of 35 minutes; intraoperative blood loss ranged from 5 to 10 ml, with a mean of 6.5 ml. All the patients were followed up, and the duration ranged from 12 to 28 months, with an average of 18 months. All the fractures healed. According to the Neer evaluation system, 59 patients got an excellent result, 5 good and 1 fair. Four patients had a small amount of secretions on the tail of the needle; 2 patients had skin irritation; 1 patient had partial withdrawal of the nail, and the skin in all the patients healed after taking out the nail. No patients had nonunion fractures due to the broken nails and loosen screws, and no vascular or nerve injuries occurred.
Traditional manipulative reduction and percutaneous elastic intramedullary nail fixation for the treatment of proximal humeral fractures in children has the advantages of less trauma, quicker recovery, less complications and simple operation.
探讨传统手法复位联合经皮弹性髓内钉固定治疗儿童肱骨近端骨折的临床疗效及安全性。
选取2012年10月至2016年5月采用传统手法复位联合经皮弹性髓内钉固定治疗的65例肱骨近端骨折患儿。其中男52例，女13例；年龄7～14岁，平均11.2岁。左侧损伤23例，右侧损伤42例。斜形骨折13例，横行骨折49例，粉碎性骨折3例。所有患儿均为闭合性、明显移位骨折，无血管神经损伤。受伤至治疗时间为20分钟至5天，平均3天。术后观察骨折愈合及并发症情况，采用Neer肩关节功能评分评价疗效。
手术时间30～40分钟，平均35分钟；术中出血量5～10毫升，平均6.5毫升。所有患儿均获随访，随访时间12～28个月，平均18个月。所有骨折均愈合。按Neer评价系统，优59例，良5例，可1例。4例针尾处有少量分泌物；2例出现皮肤刺激；1例出现髓内钉部分退出，取出髓内钉后所有患儿皮肤均愈合。无患儿因髓内钉折断、螺钉松动导致骨折不愈合，无血管神经损伤发生。
传统手法复位联合经皮弹性髓内钉固定治疗儿童肱骨近端骨折具有创伤小、恢复快、并发症少、操作简单等优点。
