Lin J, Hou S M, Hang Y S
Department of Orthopedic Surgery, National Taiwan University Hospital, Taipei, Republic of China.
J Trauma. 2000 Apr;48(4):695-703. doi: 10.1097/00005373-200004000-00018.
To report experience with use of humeral locked nails in treating humeral delayed unions and nonunions. The following techniques yielded encouragingly good results: static locking, short-to-long segment nailing, bone grafting, fracture compression, and minimal surgical trauma.
A total of 41 consecutive patients with 13 delayed unions and 28 nonunions were treated with humeral locked nails. Delay from trauma to surgery averaged 4.2 months for delayed union and 15.5 months for nonunion. The average age of patients was 50.2 years; average follow-up time was 23.2 months. There were 7 proximal-third fractures, 21 middle-third fractures, and 13 distal-third fractures. The antegrade approach was used for 13 fractures and retrograde for 28. Open nailing was performed in 39 fractures and closed nailing in 2. If the fracture motion was still present after nail insertion, axial compression of the fracture site was specially applied. Bone grafting was performed in the fractures with open nailing. Thirty-four fractures were nailed with 8-mm nails, and 7 fractures were nailed with 7-mm nails.
With a single operation, all but two patients achieved osseous union in, on average, 5.6 months. One of these two patients eventually gained union after another surgery with fracture compression along the original nail and concurrent bone grafting. The second patient, undergoing hemodialysis for chronic renal failure, had persistent nonunion. At follow-up, for patients with antegrade nailing, all but four patients had less than 20 degrees limitation of shoulder abduction. For patients with retrograde nailing, all but two had less than 10 degrees limitation of elbow motion. Only the patient with persistent nonunion had continual pain and significant impairment of arm function.
Humeral locked nailing seems to be effective for humeral delayed unions or nonunions. It may be an acceptable alternative for fractures unsuited for plate fixation, such as those with comminution, osteoporosis, or a severely adhered radial nerve.
报告使用肱骨锁定髓内钉治疗肱骨延迟愈合和不愈合的经验。以下技术取得了令人鼓舞的良好效果：静力锁定、短节段至长节段髓内钉固定、植骨、骨折加压以及最小化手术创伤。
连续41例患者，其中13例为延迟愈合，28例为不愈合，均采用肱骨锁定髓内钉治疗。延迟愈合患者从受伤至手术的平均时间为4.2个月，不愈合患者为15.5个月。患者平均年龄为50.2岁；平均随访时间为23.2个月。其中7例为肱骨近端三分之一骨折，21例为中段三分之一骨折，13例为远端三分之一骨折。13例骨折采用顺行入路，28例采用逆行入路。39例骨折采用切开髓内钉固定，2例采用闭合髓内钉固定。若髓内钉置入后骨折仍有活动，则对骨折部位进行轴向加压。切开髓内钉固定的骨折均进行了植骨。34例骨折采用8毫米髓内钉固定，7例采用7毫米髓内钉固定。
除2例患者外，其余患者均通过一次手术平均在5.6个月时实现骨愈合。这2例患者中的1例在再次手术中沿原髓内钉进行骨折加压并同时植骨后最终实现愈合。第2例患者因慢性肾衰竭接受血液透析，骨折持续不愈合。随访时，顺行髓内钉固定的患者中，除4例患者外，其余患者肩关节外展受限均小于20度。逆行髓内钉固定的患者中，除2例患者外，其余患者肘关节活动受限均小于10度。只有骨折持续不愈合的患者持续疼痛且上肢功能严重受损。
肱骨锁定髓内钉治疗肱骨延迟愈合或不愈合似乎有效。对于不适合钢板固定的骨折，如粉碎性骨折、骨质疏松性骨折或桡神经严重粘连的骨折，它可能是一种可接受的替代方法。
