闭合/切开复位钛制弹性髓内针内固定治疗严重移位的儿童肱骨近端骨折

目的评估闭合/切开复位钛制弹性髓内针（titanium elastic nails,TENs）内固定治疗严重移位的儿童肱骨近端骨折的临床疗效。方法 2009年4月至2012年6月,对我院收治的37例严重移位的小儿肱骨近端骨折患者纳入回顾性研究。所有患者均接受了闭合/切开复位TEN内固定术,通过术后的影像学结果和临床随访实现对治疗效果的评价。影像学评估包括骨折愈合和塑形情况、骨骼生长情况、是否有残留畸形等。临床评估主要包括Neer肩关节评分和术后患者的满意度。结果所有患者的平均随访周期24.0个月,影像学愈合时间7-10周,平均8周,所有患者均已达到影像学愈合。没有发现与治疗相关的并发症,2例患者因髓内针尾残留过长而产生皮肤疼痛。内固定取出时间平均为术后5.8个月,没有发现与取内固定相关的并发症。随访终末,平均Neer肩关节评分为83.00-100.00分,平均96.65分。30例患者对手术效果表示非常满意,其余7例表示满意。在随访终末所有患者的上肢运动均恢复正常。结论闭合或切开复位TEN内固定术推荐用于严重移位的小儿肱骨近端骨折,这种术式的并发症发生率低,术后恢复速度快。

Closed/open reduction and titanium elastic nails for severely displaced proximal humeral fractures in children

Objective To evaluate the clinical outcome of closed/open reduction and titanium elastic nails（TENs）in children with severely displaced proximal humeral fractures.Methods A retrospective study was performed on 37 children suffering from proximal humeral fracture between Apr.2009 and Jun.2012.All these patients were treated by closed or open reduction with TEN fixation.The healing process was assessed by radiography and clinical follow-up.Radiographic assessment was performed on the scheduled follow-ups to examine fracture healing,remodeling,bone growth and residual deformity.The clinical outcomes were evaluated using the Neer shoulder score and patients＇ satisfaction report at the final follow-up.Results All patients had a mean follow-up period of 24 months after surgery.All fractures were healed,radiologically,at a median time of 8 weeks（7 to 10 weeks）.There were no major complications related to the treatment.Two patients complained about skin irritation around the sides of the prominent distal ends of the nails.Implant removal took place at an average of 5.8months post-operatively as an outpatient procedure.There was no observed complications in association with the removal of the hardware.At the final follow-up,the mean Neer shoulder score was 96.65（range 83-100）.Thirty patients were very satisfied with their surgical outcomes and the remaining 7 were satisfied.Function of the affected arm returned to normal at the end of the follow-up period in all cases.Conclusion Combining closed or open reduction with TEN fixation is recommended for treating severely displaced proximal humeral fractures in children.Our data showed evidence of satisfactory outcomes with a low complication rate and a fast return to normal mobility of the affected arms.