摘要
目的探讨病灶清除植骨结合弹性髓内钉内固定术治疗儿童肱骨良性病变并病理性骨折的疗效及特点。方法 2007年1月-2011年1月采用病灶清除植骨结合弹性髓内钉内固定术治疗儿童肱骨良性病变并病理性骨折11例。其中男7例,女4例;年龄5～14岁,平均9.4岁。病程2～14 d,平均6 d。均为闭合性骨折。单纯骨囊肿7例,纤维结构不良3例,动脉瘤样骨囊肿1例。肱骨近端6例,肱骨干4例,肱骨远端1例。根据影像学检查,术前诊断基本明确。入院至手术时间3～5 d。结果术后切口均Ⅰ期愈合,未出现深部组织感染等并发症。11例均获随访,随访时间12～36个月,平均25.6个月。疼痛于术后6周完全消失。X线片示患儿骨折均达骨性愈合,愈合时间3～4个月,平均3.3个月。随访期间未出现病变复发或再骨折。术后10～14个月,平均12.5个月取出弹性髓内钉。末次随访时病灶完全消失(8例)或部分消失(3例);患肢无疼痛,肩、肘关节活动均不受限。1例患肢较健侧短缩约2 cm,但患肢功能及活动无影响。根据Neer肩关节和Mayo肘关节功能评分标准,11例患儿肩、肘关节功能均为优。结论病灶清除植骨结合弹性髓内钉内固定术可作为治疗儿童肱骨良性病变并病理性骨折的较理想方法,仅需单次手术干预,愈合较快、稳定性高,允许患儿早期康复锻炼,肩、肘关节功能恢复良好。
Objective To exploere the effectiveness and advantages of elastic stable intramedullary nail （ESIN） combined with curettage and graft for the treatment of benign lesions of humerus complicating by pathological fracture in children. Methods ESIN internal fixation combined with curettage and graft was used to treat benign lesions of the humerus complicating by pathological fracture in 11 children patients between January 2007 and January 2011. Of 11 patients, 7 were boy and 4 were girl, aged from 5 to 14 years （mean, 9.4 years）. The disease duration ranged from 2 to 14 days （mean, 6 days）. All fractures were closed fracture, which locations were the proximal humerus in 6 cases, the humeral shaft in 4 cases, and the distal humerus in 1 case; benign lesions of the humerus included aneurysmal bone cyst in 1 case, simple bone cyst in 7 cases, and fibrous dysplasia in 3 cases. Based on imaging studies, preoperative diagnosis was almost clear. The time from hospitalization to operation was 3-5 days Results Healing of incision by first intention was obtained in all cases, with no infection. The mean follow-up was 25.6 months （range, 12-36 months）. All patients achieved pain relief at 6 weeks postoperatively and fractures healed completely at 3 to 4 months after operation （mean, 3.3 months）. No recurrence or re-fracture was observed during follow-up. The ESIN was removed at 10-14 months after operation （mean, 12.5 months）. The lesion disappeared completely in 8 cases and partially in 3 cases. No pain of affected limb or motion limitation of shoulder and elbows was observed. One patient had limb shortening of 2 cm at last follow-up, but he had no function problem. According to Neer shoulder and Mayo elbow function scores, the results were excellent in 11 cases. Conclusion It is a good method to treat benign lesions of the humerus complicating by pathological fracture in children to use ESIN internal fixation combined with curettage and graft. After only a single operation intervention, it can provide early mechanical stability and rapid fracture healing and allow early rehabilitation exercise.
出处
《中国修复重建外科杂志》
CAS
CSCD
北大核心
2013年第1期21-24,共4页
Chinese Journal of Reparative and Reconstructive Surgery
关键词
弹性髓内钉
纤维结构不良
骨囊肿
病理性骨折
内固定
儿童
Elastic stable intramedullary nail Fibrous dysplasia Bone cyst Pathologicalfracture Internal fixation Child
