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目的:探讨弹性髓内针逆行髓内固定技术治疗大龄儿童肱骨近端骨折的临床效果。方法:2006年6月～2011年12月收治的36例大龄儿童肱骨近端骨折患儿采用弹性髓内针逆行固定治疗,其中采用经内外髁入路弹性髓内针逆行固定组14例,经外髁入路弹性髓内针逆行固定组22例。术后均采用肩关节外展支具固定6～8周。骨折愈合后去除肩关节外展支架后即行康复训练。弹性髓内针在术后3～4个月X线片显示骨折线模糊,骨折端有连续性骨小梁形成后拔除。所有患者均获6～24个月(平均13个月)随访。所有骨折均于术后8周左右愈合。未发现骨不连、肱骨头坏死、骨折再移位。结果:肩关节评价采用Constant绝对值评分方法,Constant评分为(92.2±7.1)分,其中优28例,良6例,可2例,无差病例。优良率94.4%。36例末次随访时患侧肩关节活动范围:外展平均160.5°±12.4°,前屈上举平均155.2°±14.5°,外旋平均56.5°±12.5°,内旋平均62.3°±15.5°。3例出现针尾激惹,1例术后出现尺神经麻痹症状。结论:采用弹性髓内针逆行髓内固定技术治疗大龄儿童肱骨近端骨折具有创伤小、术中出血少,手术时间短,手术疤痕小,良好的肩关节功能等优点,是临床治疗大龄儿童肱骨近端骨折的理想方法。
Objective: To investigate the clinical effect of elastic intramedullary nail retrograde intramedullary nailing in the treatment of proximal humerus fractures in older children. METHODS: Thirty-six children with proximal humerus fractures admitted from June 2006 to December 2011 were treated with retrograde intramedullary nailing. Among them, 14 cases were treated with retrograde intramedullary nailing via the medial and lateral condyles, Lateral condyle approach elastic nailing retrograde fixation group of 22 cases. Postoperative shoulder abduction brace were fixed for 6 to 8 weeks. Fracture healing after removing the shoulder joint outreach stent rehabilitation training. Elastic intramedullary nail in the postoperative 3 to 4 months X-ray showed fracture lines blurred fracture of the trabecular bone after the removal of the formation. All patients were followed up for 6 to 24 months (average 13 months). All fractures healed after about 8 weeks. Not found nonunion, humeral head necrosis, fracture and then shift. Results: Constant absolute score was used for the evaluation of shoulder. The Constant score was (92.2 ± 7.1) points, of which 28 were excellent, 6 were good and 2 were fair. Excellent rate of 94.4%. 36 patients at the last follow-up range of ipsilateral shoulder joint activity range: an average of 160.5 ° ± 12.4 ° abduction, flexion on the average of 155.2 ° ± 14.5 °, external rotation average 56.5 ° ± 12.5 °, internal rotation average 62.3 ° ± 15.5 °. Three cases of needle tail irritation, ulnar nerve paralysis occurred in 1 case. Conclusion: The use of elastic intramedullary nailing retrograde intramedullary nailing in the treatment of proximal humerus fractures in older children has the advantages of less trauma, less intraoperative bleeding, shorter operative time, fewer surgical scars and good shoulder function. It is an effective method for the treatment of elderly humerus The ideal method of proximal fracture.