石伟 唐盛平 黄子龙

【摘要】 目的：分析闭合复位弹性髓内钉内固定治疗儿童长骨干骨折的效果。方法：回顾性分析2017年1-12月本院收治的儿童长骨干骨折的病例共158例，其中82例采用弹性髓内钉治疗作为观察组，76例采用一般髓内钉治疗作为对照组。对比两组术中出血量、手术时间、住院时间、骨折愈合时间与下地时间;对比两组临床疗效及并发症发生率。结果：观察组术中出血量、手术时间、住院时间及下地时间均明显少于对照组（P<0.05）;观察组上肢、下肢的骨折愈合时间均短于对照组（P<0.05）;观察组临床优良率高于对照组（P<0.05）;观察组并发症发生率低于对照组（P<0.05）。结论：儿童长骨干骨折采用闭合复位弹性髓内钉内固定治疗操作方便，耗时少，创伤小，能有效提高临床疗效，减少并发症发生率，加快术后骨折愈合进程，值得临床推广。

【关键词】 闭合复位; 弹性髓内钉; 儿童长骨干骨折

【Abstract】 Objective：To analyze the effect of closed reduction and elastic intramedullary nailing in the treatment of long bone fracture in children.Method：Retrospective analysis of 158 cases of long bone fracture of children admitted to our hospital from January to December 2017.Among them，82 cases treated with elastic intramedullary nail as the observation group and 76 cases treated with general intramedullary nail as the control group.The intraoperative blood loss，operation time，hospitalization time，fracture healing time and ambulation time were compared between the two groups.The clinical efficacy and complication rate of the two groups were compared.Result：The intraoperative blood loss，operation time，hospitalization time and ambulation time in the observation group were significantly less than those in the control group（P<0.05）.The healing time of the upper and lower limbs in the observation group were shorter than those in the control group（P<0.05）.The excellent rate in the observation group was higher than that of the control group（P<0.05）.The incidence of complications in the observation group was lower than that in the control group（P<0.05）.Conclusion：The application of closed reduction and elastic intramedullary nail internal fixation for the treatment of childrens long bone fractures is convenient，time-consuming and minimally invasive，it can effectively improve the clinical efficacy，reduce the incidence of complications and accelerate the postoperative fracture healing process，it is worthy of clinical promotion.

【Key words】 Closed reduction; Elastic intramedullary nail; Long bone fracture in children

First-authors address：Shenzhen Childrens Hospital，Shenzhen 518026，China

doi：10.3969/j.issn.1674-4985.2019.17.038

长骨干骨折是儿童常见骨科疾病，常由直接暴力所致。既往多采取手法复位石膏外固定、各种牵引及切开复位钢板内固定等治疗方式，但存在护理困难、创伤大、效果差、并发症多等问题，严重影响患儿的生长发育[1]。近年来随着髓内钉固定技术的发展，弹性髓内钉已逐渐成为治疗儿童长骨干骨折的首选，但临床效果尚无研究报道[2]。本研究以本院收治的158例儿童长骨干骨折病例作为研究对象，对比闭合复位弹性髓内钉内固定与克氏针操纵一般髓内钉内固定两种方式的優劣差异，取得良好的效果，现报道如下。

1 资料与方法

1.1 一般资料 回顾性分析2017年1-12月本院收治的儿童长骨干骨折的病例共158例。纳入标准：（1）具有长骨干骨折症状，经X线检查确诊;（2）闭合性骨折;（3）无神经、血管损伤;（4）骨折时间<7 d。排除标准：（1）合并严重的脏器损伤;（2）病理性骨折;（3）粉碎性骨折;（4）关节内骨折或骨折部位距离关节较近;（5）具有手术禁忌证。其中82例采用弹性髓内钉治疗作为观察组，76例采用一般髓内钉治疗作为对照组。本研究已经医院伦理委员会批准。

1.2 方法 术前准备，两组均采用全身麻醉。观察组，取仰卧位，常规消毒铺巾，下肢胫骨干骨折……