Lin Jinn, Hou Sheng-Mou
Department of Orthopedic Surgery, National Taiwan University Hospital, Taipei.
J Trauma. 2003 Mar;54(3):530-5. doi: 10.1097/01.TA.0000034588.37392.C2.
The authors' purpose was to report their experience with the use of locked nails in treating humeral surgical neck nonunions. Locked nailing has the advantages of minimal soft tissue trauma, automatic fracture reduction, and stable fracture fixation.
Excluding 3 patients with severe medical illness, a total of 15 consecutive patients with 15 nonunions were treated by humeral locked nailing and bone grafting. Delay from trauma to surgery averaged 13.8 months, and 10 patients had previous operations. The average age of patients was 55.1 years; average follow-up time was 22.4 months. There were two hypertrophic and 13 atrophic nonunions. The average preoperative Neer score for shoulder joints was 53.5. All but three cases had varus deformity, with an average angle of 32.3 degrees.
Seven nonunions were nailed with 8-mm nails and eight with 7-mm nails. With a single operation, all but one patient achieved osseous union in an average of 5.4 months. This one patient, who had a Neer score of 72, refused further surgery. At follow-up, 13 of the 15 patients had excellent or good functional recovery of shoulder joints, with an average Neer score of 86.7. Four patients had residual varus angulation averaging 15.5 degrees. For patients with solid union, the average range of shoulder motion was 152.3 degrees in flexion and 146.4 degrees in abduction. No patients had significant limitation of elbow motion. Three patients had occasional shoulder pain and no patients had evident shoulder impingement.
For humeral surgical neck nonunions in which the head fragment still preserves the greater tuberosity, locked nailing with transfixing screws appeared to be a useful alternative, especially in fractures with osteoporosis, severe varus deformity, or severe soft tissue scarring.
作者旨在报告使用锁定髓内钉治疗肱骨干外科颈骨不连的经验。锁定髓内钉具有软组织创伤小、自动骨折复位和骨折固定稳定的优点。
排除3例患有严重内科疾病的患者，共有15例连续的15处骨不连患者接受了肱骨干锁定髓内钉固定及植骨治疗。从受伤至手术的平均间隔时间为13.8个月，10例患者曾接受过手术。患者的平均年龄为55.1岁；平均随访时间为22.4个月。有2例肥大性骨不连和13例萎缩性骨不连。术前肩关节的平均Neer评分为53.5分。除3例病例外，所有病例均有内翻畸形，平均角度为32.3度。
7例骨不连用8毫米的髓内钉固定，8例用7毫米的髓内钉固定。单次手术中，除1例患者外，所有患者平均在5.4个月时实现了骨愈合。该例患者Neer评分为72分，拒绝进一步手术。随访时，15例患者中有13例肩关节功能恢复优良，平均Neer评分为86.7分。4例患者残留平均15.5度的内翻成角。对于已实现牢固愈合的患者，肩关节的平均活动范围为前屈152.3度、外展146.4度。没有患者出现明显的肘关节活动受限。3例患者偶尔有肩部疼痛，没有患者有明显的肩部撞击。
对于肱骨干外科颈骨不连且头部骨折块仍保留大结节的情况，带锁定螺钉的锁定髓内钉固定似乎是一种有效的替代方法，尤其适用于伴有骨质疏松、严重内翻畸形或严重软组织瘢痕的骨折。
