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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 investigate the efficacy and characteristics of debridement and bone grafting combined with elastic intramedullary nails in the treatment of benign and pathological fractures of humerus in children. Methods From January 2007 to January 2011, 11 cases of benign and pathological fractures of humerus were treated with debridement and bone grafting combined with elastic intramedullary nailing. Including 7 males and 4 females; aged 5 to 14 years, mean 9.4 years. Course of 2 ~ 14 d, an average of 6 d. Are closed fractures. Seven cases of simple bone cyst, fibrous dysplasia in 3 cases, aneurysmal bone cyst in 1 case. 6 cases of proximal humerus, 4 cases of humeral shaft, 1 case of distal humerus. According to imaging examination, the basic preoperative diagnosis clear. Admission to operation time 3 ~ 5 d. Results All the wounds healed in the first period without complication such as deep tissue infection. Eleven patients were followed up for 12 to 36 months with an average of 25.6 months. Pain completely disappeared 6 weeks after surgery. X-ray showed that children with fractures were up to bone healing, healing time 3 to 4 months, an average of 3.3 months. No recurrence or re-fracture of the lesion occurred during follow-up. After 10 to 14 months, an average of 12.5 months to remove the elastic nail. At final follow-up, the lesions disappeared completely (8 cases) or disappeared partially (3 cases). No pain was found in the affected limbs and the activities of shoulder and elbow joint were not limited. One limb contracted 2 cm shorter than the contralateral side, but had no effect on limb function and activity. According to Neer shoulder and Mayo elbow function score, 11 cases of shoulder and elbow joint function are excellent. Conclusion Lesions and bone grafting combined with elastic intramedullary nailing can be used as a more ideal method to treat benign lesions and pathological fractures of the humerus in children. Only a single surgical intervention is needed, which results in rapid healing and high stability. Early rehabilitation rehabilitation Shoulder, elbow function recovered well.