Flinkkilä Tapio, Hyvönen Pekka, Siira Pertti, Hämäläinen Martti
Department of Surgery, Division of Orthopaedic and Trauma Surgery, University Hospital, Kajaanintie 52, 90220 Oulu, Finland.
Arch Orthop Trauma Surg. 2004 Oct;124(8):537-41. doi: 10.1007/s00402-004-0727-9. Epub 2004 Aug 24.
Antegrade intramedullary (IM) nailing of humeral shaft fractures is reported to cause shoulder joint impairment. This retrospective study compared shoulder joint symptoms, range of motion (ROM), and isometric strength after antegrade IM nailing and dynamic compression (DC) plating of humeral shaft fractures.
We compared 29 patients with DC plating and 44 with antegrade IM nailing of their humeral shaft fractures. Shoulder pain, L'Insalata and Constant scores, shoulder joint ROM and isometric shoulder strengths were measured after mean follow-up of 6.2 (1-15) years (DC plating) and 5.5 (2-10) years (IM nailing).
Patients had nonsignificantly more shoulder pain after IM nailing than after DC plating. Shoulder scores and isometric strength measurements showed no difference between the groups. Flexion was significantly better after DC plating, but none of the other ROM parameters differed between the groups. The shoulder scores and all ROM and strength parameters of the injured side were significantly lower than on the uninjured side in both groups.
Shoulder joint ROM and strength does not recover to normal after humeral shaft fracture. Antegrade IM nailing if performed properly is not responsible for shoulder joint impairment.
据报道，肱骨干骨折顺行髓内钉固定会导致肩关节功能受损。本回顾性研究比较了肱骨干骨折顺行髓内钉固定和动力加压钢板固定术后的肩关节症状、活动范围（ROM）和等长肌力。
我们比较了29例行动力加压钢板固定和44例行肱骨干骨折顺行髓内钉固定的患者。在平均随访6.2（1 - 15）年（动力加压钢板固定组）和5.5（2 - 10）年（髓内钉固定组）后，测量肩关节疼痛、L'Insalata评分和Constant评分、肩关节活动范围及等长肌力。
髓内钉固定术后患者的肩关节疼痛略多于动力加压钢板固定术后，但差异无统计学意义。两组间肩关节评分和等长肌力测量结果无差异。动力加压钢板固定术后的前屈明显更好，但两组间其他活动范围参数无差异。两组中患侧的肩关节评分以及所有活动范围和肌力参数均显著低于健侧。
肱骨干骨折后肩关节活动范围和肌力无法恢复至正常。如果操作得当，顺行髓内钉固定不会导致肩关节功能受损。
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