关键词: 肩骨折, 外固定器, 儿童

Abstract: Objective  To analyze the clinical effects of two minimally invasive fixation methods in the treatment of proximal humeral fractures(PHF) in adolescents aged 10 to 14 years. 
Methods  We performed a retrospective analysis of clinical efficacy of 52 children aged 10-14 years with PHF. Twenty-four patients in the observation group received percutaneous Kirschner wire internal fixation combined with external fixation for maintenance treatment, while 28 patients in the control group received percutaneous Kirschner wire fixation combined with plaster external fixation. The duration of operation, intraoperative blood loss, intraoperative fluoroscopy times, length of hospitalization, time of affected limb movement after operation, visual analogue scale(VAS) score of upper arm pain at 3 and 7 d after operation, fracture healing time, shoulder joint function Neer score and elbow Mayo score, postoperative complications and hospitalization expenses were analyzed. 
Results  All patients had Neer type Ⅱ and Ⅲ fractures. They were followed up for 15 months. There was no significant difference in general condition between  two groups(P＞0.05). There was no significant difference in duration of operation, intraoperative blood loss, intraoperative fluoroscopy times, VAS score at 3 and 7 d after operation, fracture healing time and postoperative complications between two groups(P＞0.05). Compared with the control group, the length of hospitalization and time of affected limb movement after operation were significantly shorter in the observation group, but the hospitalization expenses were higher(P＜0.05). The Neer scores and Mayo scores of the shoulder joints of the two groups showed a gradual upward trend at 3 months, 6 months and 15 months after surgery. The difference of interaction between groups, time points, and time points between groups were statistically significant(P＜0.05). All the patients had stageⅠhealing without infection, vascular or nerve injury. At the last follow-up, all patients had no growth disorder and angular deformity caused by epiphyseal plate closure or bone bridge for mation. 
Conclusion  The two fixation methods can achieve good results in the treatment of PHF in older children. Compared with plaster external fixation, external fixator for maintenance treatment after percutaneous Kirschner wire fixation can significantly shorten the length of hospitalization of patients and the time of affected limb movement after operation. It is a safe and effective scheme of minimally invasive fixation, but it will increase the hospitalization expenses of patients. 

Key words: shoulder fractures, external fixators, children