三种内固定方案在大龄肱骨近端骨折病人中的应用效果比较

目的:比较切开复位克氏针内固定手术、切开复位接骨板内固定手术、弹性髓内针逆行髓内固定手术三种内固定方案在大龄肱骨近端骨折患儿中的疗效。方法:回顾性分析2010年1月至2016年1月手术治疗的150例肱骨近端骨折大龄儿童的临床资料，根据患儿不同手术方案将病人分为3组，分别为克氏针组、接骨板组、髓内针组，比较3组患儿的手术时间、术中出血量、切口长度、住院时间、骨折愈合时间、Constant评分、输血情况、预后优良率、并发症发生率等临床资料的差异。结果:3组手术时间、术中出血量和切口长度3个指标均为:接骨板组最大（P<0.01），克氏针组次之（P<0.01），髓内针组最小（P<0.01）；3组病人的住院时间、骨折愈合时间、术后1个月Constant评分、术后3个月Constant评分、术中输血率、预后优良率和并发症发生率7项指标差异均无统计学意义（P>0.05）。结论:弹性髓内针逆行髓内固定手术治疗手术时间短、术中出血量少，切口长度小，骨折愈合快速，是临床工作中比较理想的治疗方法，值得广泛推广。

Comparison of the application effect of three kinds of internal fixation in the treatment of proximal humeral fractures in older children

Objective:To compare the effects among the Kirschner wire fixation,steel plate fixation and elastic intramedullary nail intramedullary fixation in the treatment of proximal humerus fractures in older children.Methods:The clinical data of 150 older children with proximal humerus fractures from January 2010 to January 2016 were retrospectively analyzed.The patients were divided into the Kirschner wire group,steel plate group and intramedullary nail group according to the operation way.The differences of the operation time,intraoperative blood loss,incision length,hospitalization time,fracture healing time,Constant score,blood transfusion,excellent prognosis and incidence rate of complications among three groups were compared.Results:The operation time,intraoperative blood loss and incision length in plate group,Kirschner wire group and intramedullary nail group gradually decreased(P<0.01).The differences of the hospitalization time,fracture healing time,postoperative 1 and 3 months Constant scores,intraoperative blood transfusion,excellent rate of prognosis and incidence rate of complications among three groups were not statistically significant(P>0.05).Conclusions:Elastic intramedullary nail intramedullary fixation treatment has little operation time,intraoperative blood loss and incision length,and quick healing,which is an ideal treatment means,and worthy of promotion.