弹性髓内钉在儿童肱骨干骨折治疗中的应用

目的探讨弹性髓内钉治疗儿童肱骨干骨折的临床效果。方法对37例肱骨干骨折(经手法复位不满意或手法复位石膏固定后再移位)患儿采取闭合复位、小切口弹性髓内钉内固定治疗。除2例因手法复位失败采用有限切开复位外,其余均采用闭合复位。分别于术后3、6、12个月对患儿肩、肘关节功能进行评分。结果 37例均获随访,时间6～24个月,2例因钉尾过长或折弯致肱骨进针点疼痛和钉尾刺激反应,拔钉后症状消失。骨折全部骨性愈合,愈合时间3～6个月。均无感染、短缩、旋转畸形以及骨骺、神经损伤等并发症发生。采用Constant和Murley肩关节评分系统、Mayo肘关节功能评分系统评价疗效,术后12个月疗效:优20例,良15例,可2例,优良率为94.59%。结论弹性髓内钉内固定治疗儿童肱骨干骨折创伤小,可早期活动,愈合快,并发症少。

Elastic intramedullary nailing for children with fracture of shaft of humerus

Objective To disscuss the effect of elastic intramedullary nailing for children with fracture of shaft of humerus.Methods 37 patients with fracture of shaft of humerus who were not satisfied by the manual reduction or got displacement after manual reduction and plaster fixation were undergone closed reduction,and flexible intramedullary nail fixation through a small incision.Except two cases with limited open reduction due to manual reduction failure,the others all got closed reduction.The results were assessed by the shoulder and elbow function score of the children after operation in 3,6,and 12 months respectively.Results All patients were followed up for 6～24 months.Two cases got the needle point pain and nail stimulation due to too long or bending,but the symptoms disappeared after the nails were pulled out.All got bone healing,and healing time for 3～6 months.No infection,shortening,rotational deformity,epiphysis and nerve damage and other complications occurred.The results were excellent in 20 cases,good in 15,fair in 2,and poor in 2,and the excellent and good rate was 94.59% according to Constant and Murley shoulder scoring system and the Mayo elbow performance score system after 12 months.Conclusions Elastic intramedullary nailing has many advantages in pediatric humeral shaft fractures,such as minimal trauma,early rehabilitation,fast healing,and less complications.