微创逆行插弹性钉治疗儿童移位锁骨骨折

目的 :研究闭合复位下逆行插钛质弹性髓内钉内固定治疗儿童移位锁骨骨折的应用和疗效。方法 :自2014年1月至2016年11月采用闭合复位下逆行插钛质弹性髓内钉治疗26例儿童移位锁骨骨折,男14例,女12例;年龄7~14岁,平均9.2岁。受伤至手术时间2~7 d,平均2.8 d。采用VAS评分对患者术前及术后2 d的主诉疼痛进行比较,采用肩关节Neer评分比较术后2个月患侧与健侧肩关节功能情况。结果:26例均获得随访,时间6~12个月。所有病例切口愈合好,无感染、无断钉或弹性髓内钉退出等并发症,均达到解剖复位,骨性愈合良好,术后肩关节活动度恢复良好,平均取钉时间14~32(16.25±2.62)周。术后2 d疼痛VAS评分较术前明显缓解(P0.05)。术后2个月患侧肩关节Neer评分98.46±1.07,与健侧98.58±1.10比较,差异无统计学意义(P0.05)。结论:钛质弹性髓内钉固定治疗儿童移位锁骨骨折具有微创、术后不影响皮肤美观、骨折愈合快、术后功能恢复好、拔钉简便、并发症少等优点。

Minimally invasive retrograde insertion of elastic intramedullary nails for displaced clavicle fractures in children

Objective: To study the application and effect of retrograde titanium elastic nails fixation for the treatment of displaced clavicle fracture in children under closed reduction.Methods: From January 2014 to November 2016,26 children with displaced fractures of the clavicle were treated by closed reduction and retrograde inserted titanium elastic nails including 14 boys and 12 girls with an average age of 9.2 years old ranging from 7 to 14 years. Time from injury to operation was 2 to 7 days with an average of 2.8 days. Visual analogue score (VAS) was used to evaluate the main complaint pain in all patients before and 2 days after operation. The Neer score of shoulder function between affected side and healthy side at 2 months after operation were compared.Results: All the 26 children were followed up for 6 to 12 months. All cases healed well without infection,broken nails or titanium elastic nails exit complications. All children achieved anatomical reduction,good bony union,and good recovery of shoulder joint activity. The average time of removing nail was 14 to 32(16.25±2.62) weeks. The pain VAS score was significantly relieved 2 days after operation (P<0.05). At 2 months after operation,the Neer score of shoulder joint was 98.46±1.07 in affected side and 98.58±1.10 in healthy side respectively,there was no significant difference between the two groups (P>0.05).Conclusion: Titanium elastic intramedullary nail fixation for the treatment of displaced clavicular fracture in children has the advantages of minimal invasion,no effect on skin beauty,rapid healing of fracture,good recovery of postoperative function,simple nailing and less complications.