Wu C C, Shih C H
Department of Orthopedic Surgery, Chang Gung Memorial Hospital, Chang Gung Medical College, Taiwan, ROC.
Can J Surg. 1992 Dec;35(6):661-5.
From July 1986 to November 1989, fractures of the humeral shaft in 35 adults who had nonunion of the fracture were managed by plate fixation (19 patients) or antegrade nailing of the fracture fragments with the Seidel interlocking nail (16 patients) together with cancellous bone grafting. The follow-up period ranged from 12 to 52 months. Of the patients who had plate fixation, 89.5% had fracture union within 4.5 +/- 1.7 months; of the patients whose fracture was managed with the Seidel interlocking nail, 87.5% had fracture union within 4.4 +/- 1.8 months. The range of shoulder motion was improved with both techniques. Patients who had plate fixation had more complications than those whose fracture was managed by interlocking nailing (21% v. 12%). The authors prefer interlocking nailing because it is a relatively simpler technique, resulting in fewer complications. It may replace plating in the treatment of nonunion of humeral shaft fractures. However, rotatory instability with interlocking nailing cannot be disregarded, and if this is evident plate fixation should be done.
1986年7月至1989年11月，对35例肱骨干骨折不愈合的成年患者采用钢板固定（19例）或使用Seidel交锁髓内钉对骨折碎片进行顺行髓内钉固定（16例）并同时植骨治疗。随访时间为12至52个月。采用钢板固定的患者中，89.5%在4.5±1.7个月内骨折愈合；采用Seidel交锁髓内钉治疗的患者中，87.5%在4.4±1.8个月内骨折愈合。两种技术均使肩部活动范围得到改善。采用钢板固定的患者比采用交锁髓内钉治疗的患者并发症更多（21%对12%）。作者更倾向于交锁髓内钉固定，因为它是一种相对简单的技术，并发症较少。在肱骨干骨折不愈合的治疗中它可能会取代钢板固定。然而，交锁髓内钉固定时的旋转不稳定不能被忽视，如果明显存在这种情况，则应采用钢板固定。
