Gaullier O, Rebaï L, Dunaud J L, Moughabghab M, Benaissa S
Service d'Orthopédie Traumatologie, S.O.S Mains Picardie.
Rev Chir Orthop Reparatrice Appar Mot. 1999 Jul;85(4):349-61.
The Seidel intramedullary locking nail is one of the alternative methods for operative treatment of humeral shaft fractures. Short follow-up demonstrated persistent pain and stiffness at the shoulder joint. The aims of this retrospective study were first to evaluate results with attention to operative technique, consolidation rate and postoperative complications. Second we studied rotator cuff healing in our first patients.
Twenty-five acute diaphyseal fractures were treated between May 91 and Dec 94. We reviewed personally 23 patients with a mean follow-up of 33 months (range 22-66). The dominant fracture type according to AO was type A. Clinical shoulder assessment was carried out using the Constant score. Isometric strength was recorded in both shoulders with a hand-held dynamometer in abduction, external and internal rotation. Sonographic evaluation of the rotator cuff was performed using a 7.5 MHz linear array transducer in all 23 patients.
All but one fracture healed at an average of two months. Impingement was observed in three patients but pain relief and normal shoulder motion have been reached after nail removal. Infection occurred in one patient but final result was good. Constant score averaged 78.7 (range 51-94.2) classifying the result in all but two patients as excellent or good. Compared with the external and internal rotations, strength was significantly reduced in abduction but reached 83.5 per cent of the opposite shoulder. No statistical differences were found in relation with age, gender and side. Compared with the contralateral shoulder, rotator cuff evaluation with sonography was considered as normal in 18 patients. Calcium deposits of the cuff were noticed in the infected patient. In three cases sonography detected hyperechoic line considered as scar in the supraspinatus tendon without any partial or full-thickness tear.
A median starting point avoids the avascular area and gives a straight access to the medullary canal. This study demonstrates that using this entry portal and a reliable technique antegrade nailing of the humerus does not compromise rotator cuff healing and shoulder function. Technical errors lead to poor or fair results but despite this learning curve, Seidel nail when operative treatment is indicated, is a good choice. Attention must be paid to patients with clinical history of impingement or rotator cuff tendinopathy.
赛德尔髓内锁定钉是肱骨干骨折手术治疗的替代方法之一。短期随访显示肩关节持续疼痛和僵硬。这项回顾性研究的目的首先是评估手术技术、骨愈合率和术后并发症的结果。其次，我们研究了首批患者的肩袖愈合情况。
1991年5月至1994年12月期间治疗了25例急性骨干骨折。我们亲自复查了23例患者，平均随访33个月（范围22 - 66个月）。根据AO分型，主要骨折类型为A型。使用Constant评分进行临床肩部评估。用手持测力计记录双肩在外展、外旋和内旋时的等长肌力。对所有23例患者使用7.5MHz线阵探头进行肩袖的超声评估。
除1例骨折外，所有骨折平均在两个月时愈合。3例患者出现撞击，但取出钉子后疼痛缓解且肩部活动恢复正常。1例患者发生感染，但最终结果良好。Constant评分平均为78.7（范围51 - 94.2），除2例患者外，所有患者的结果均评为优秀或良好。与外旋和内旋相比，外展时力量明显降低，但达到对侧肩部的83.5%。在年龄、性别和患侧方面未发现统计学差异。与对侧肩部相比，18例患者的肩袖超声评估正常。在感染患者中发现肩袖有钙沉积。3例患者超声检查发现冈上肌腱内有高回声线，考虑为瘢痕，无部分或全层撕裂。
中位起始点可避免无血管区域，并能直接进入髓腔。本研究表明，采用该入路和可靠技术进行肱骨顺行髓内钉固定不会影响肩袖愈合和肩部功能。技术失误会导致结果不佳或尚可，但尽管存在这个学习曲线，在需要手术治疗时，赛德尔钉仍是一个不错的选择。对于有撞击或肩袖肌腱病临床病史的患者必须予以关注。
