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[1]黃楊,王昌興,鄒陽.AO鈦制彈性髓內(nèi)釘內(nèi)固定與切開復(fù)位鋼板內(nèi)固定治療 小兒肱骨干中下段骨折的比較研究[J].中醫(yī)正骨,2015,27(07):22-26.
　HUNAG Yang,WANG Changxing,ZOU Yang.A comparative study of AO titanium elastic stable intramedullary nail internal fixation versus open reduction plate osteosynthesis for the treatment of mid-distal humeral fractures in children[J].The Journal of Traditional Chinese Orthopedics and Traumatology,2015,27(07):22-26.
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AO鈦制彈性髓內(nèi)釘內(nèi)固定與切開復(fù)位鋼板內(nèi)固定治療 小兒肱骨干中下段骨折的比較研究()
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《中醫(yī)正骨》[ISSN:1001-6015/CN:41-1162/R]

卷:
第27卷
期數(shù):
2015年07期
頁碼:
22-26
欄目:
臨床研究
出版日期:
2015-07-31

文章信息/Info

Title:
A comparative study of AO titanium elastic stable intramedullary nail internal fixation versus open reduction plate osteosynthesis for the treatment of mid-distal humeral fractures in children
作者:
黃楊1; 王昌興2; 鄒陽1
1.浙江中醫(yī)藥大學(xué),浙江 杭州 310053;
2.浙江中醫(yī)藥大學(xué)附屬第二醫(yī)院,浙江 杭州 310005
Author(s):
HUNAG Yang1; WANG Changxing2; ZOU Yang1
1.Zhejiang university of traditional Chinese medicine,Hangzhou 310053,Zhejiang,China
2.The second affiliated hospital of Zhejiang university of traditional Chinese medicine,Hangzhou 310005,Zhejiang,China
關(guān)鍵詞:
肱骨骨折;  兒童;  骨折固定術(shù); 內(nèi);  彈性髓內(nèi)釘;  鋼板;  治療; 臨床研究性
Keywords:
humeral fractures;  child;  fracture fixation; internal;  elastic intramedullary nails;  plates;  therapies; investigational
摘要:
目的:比較AO鈦制彈性髓內(nèi)釘內(nèi)固定與切開復(fù)位鋼板內(nèi)固定治療小兒肱骨干中下段骨折的臨床療效和安全性。方法:回顧性分析47例肱骨中下段骨折患兒的病例資料,其中采用切開復(fù)位鋼板內(nèi)固定28例,采用AO彈性髓內(nèi)釘內(nèi)固定19例。男27例,女20例; 年齡6～11歲,中位數(shù)8歲; 肱骨干中段骨折16例,下段骨折31例; 左側(cè)16例,右側(cè)31例; 按照肱骨干骨折的AO分型,A型15例、B型23例、C型9例。比較2組患者術(shù)中出血量、手術(shù)時間、住院時間、骨折愈合時間,及術(shù)后6個月的肩關(guān)節(jié)活動度、肘關(guān)節(jié)活動度、美國加州大學(xué)(the University of California at Los Angeles,UCLA)肩關(guān)節(jié)功能評分和Mayo肘關(guān)節(jié)功能評分,并比較2組患者并發(fā)癥發(fā)生情況。結(jié)果:AO彈性髓內(nèi)釘內(nèi)固定組術(shù)中出血量少于切開復(fù)位鋼板內(nèi)固定組[(95.00±33.39)mL,(192.00±48.18)mL,t=7.560,P=0.000],其手術(shù)時間、骨折愈合時間均短于切開復(fù)位鋼板內(nèi)固定組[(55.50±12.79)min,(71.60±16.45)min,t=3.585,P=0.001;(9.40±3.04)min,(12.80±4.50)min,t=2.860,P=0.006]; 2組患者住院時間比較,差異無統(tǒng)計(jì)學(xué)意義[(12.60±1.64)min,(12.70±1.92)min,t=0.184,P=0.855]。術(shù)后6個月AO彈性髓內(nèi)釘內(nèi)固定組肩關(guān)節(jié)活動度、肘關(guān)節(jié)活動度均大于切開復(fù)位鋼板內(nèi)固定組[153.95°±16.29°,112.68°±20.21°,t=7.410,P=0.000; 132.00°±6.70°,113.18°±6.78°,t=9.382,P=0.000],其UCLA肩關(guān)節(jié)功能評分、Mayo肘關(guān)節(jié)功能評分均高于切開復(fù)位鋼板內(nèi)固定組[(32.26±2.45)分,(26.50±3.10)分,t=6.790,P=0.000;(96.52±2.95)分,(87.46±3.94)分,t=8.520,P=0.000]。AO彈性髓內(nèi)釘內(nèi)固定組并發(fā)癥發(fā)生率小于切開復(fù)位鋼板內(nèi)固定組(χ2=4.970,P=0.026)。結(jié)論:與切開復(fù)位鋼板內(nèi)固定相比,采用AO鈦制彈性髓內(nèi)釘內(nèi)固定治療小兒肱骨干中下段骨折,創(chuàng)傷小、手術(shù)時間短、骨折愈合快,肩、肘關(guān)節(jié)活動度及功能恢復(fù)好,可作為臨床治療小兒肱骨干中下段骨折的一種較為理想的選擇。但二者住院時間無明顯差異。
Abstract:
Objective:To compare the clinical effects and safety of internal fixation with AO titanium elastic stable intramedullary nail(ESIN)versus open reduction internal fixation(ORIF)with plate for treatment of mid-distal humeral fractures in children.Methods:The medical records of forty-seven children with mid-distal humeral fractures were analyzed retrospectively.Twenty-eight cases were treated with ORIF with plate while 19 cases were treated with ESIN internal fixation.The patients consisted of 27 males and 20 females,and ranged in age from 6 to 11 years(Median=8 yrs).Sixteen cases suffered from mid humeral fractures and 31 cases suffered from distal humeral fractures.The fractures located in left humerus for 16 cases and right humerus for 31 cases.According to the AO classification of humeral shaft fractures,the fractures belonged to type A(15),type B(23)and type C(9).The intraoperative blood loss,operative time,hospital stay time,fracture healing time and complications were compared between the 2 groups.The range of motion(ROM)of shoulder joint and elbow joint,UCLA shoulder performance score and Mayo elbow performance score were recorded at 6 months after the surgery and compared between the 2 groups.Results:The intraoperative blood loss was less in ESIN group compared to ORIF group(95.00+/-33.39 vs 192.00+/-48.18 mL,t=7.560,P=0.000),and the operative time and fracture healing time were shorter in of ESIN group compared to ORIF group (55.50+/-12.79 vs 71.60+/-16.45 min,t=3.585,P=0.001; 9.40+/-3.04 vs 12.80+/-4.50 min,t=2.860,P=0.006).There was no statistical difference in hospital stay between the two groups(12.60+/-1.64 vs 12.70+/-1.92 min,t=0.184,P=0.855).At 6 months after the surgery,the range of motion of shoulder joint and elbow joint were higher in ESIN group compared to ORIF group(153.95+/-16.29 degrees vs 112.68+/-20.21 degrees,t=7.410,P=0.000; 132.00+/-6.70 vs 113.18+/-6.78 degrees,t=9.382,P=0.000).Both UCLA shoulder performance score and Mayo elbow performance score were higher in ESIN group compared to ORIF group(32.26+/-2.45 vs 26.50+/-3.10 points,t=6.790,P=0.000; 96.52+/-2.95 vs 87.46+/-3.94 points,t=8.520,P=0.000).The incidence rate of complications were lower in ESIN group compared to ORIF group(χ2=4.970,P=0.026).Conclusion:Compared with open reduction plate internal fixation,AO titanium elastic stable intramedullary nail internal fixation has such advantages as less injury,shorter operative time,shorter fracture healing time and larger range of motion and better performance of shoulder joint and elbow joint,so it can be used as a comparatively ideal method for treatment of mid-distal humeral shaft fractures in children.However,there is no obvious difference in hospital stay between the 2 methods.

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備注/Memo

備注/Memo:
2015-03-01收稿 2015-04-02修回
通訊作者:王昌興 E-mail:[email protected]
更新日期/Last Update: 2015-07-30