Li Wen-yi, Zhang Bo-song, Zhang Long, Zheng Shu-hui, Wang Shu mao
Department of Orthopaedics, Hebei General Hospital, Shijiazhuang 050051, Hebei, China.
Zhongguo Gu Shang. 2009 Mar;22(3):199-201.
To compare therapeutic effects between antegrade intramedullary nailing and retrograde intramedullary nailing for the treatment of humeral shaft fractures.
From March 1999 to October 2006, 105 patients with humeral shaft fractures were treated with locked intramedullary nail and were adequately followed up. There were 82 antegrade nailing and 23 retrograde nailing. The follow-up parameters included operation time, blood loss,fracture healing rate, healing time, complications, Constant-Murley shoulder score and Mayo elbow performance score.
The mean follow-up period was 31.2 months. Antegrade intramedullary nailing had significantly less blood loss than that in retrograde intramedullary nailing (P=0.002). The differences in operation time, complications, healing time and bone healing rate between he two groups had no statistical significance. Complications in the antegrade intramedullary nail group included 4 patients with nonunions, 1 patient with radial nerve palsy, and 8 patients with shoulder pains and decrement in shoulder range of motion. Complications in the retrograde intramedullary nail group included 1 patient with radial nerve palsy and 3 patients with iatrogenic fractures. For shoulder joints,the difference in the average Constant-Murley shoulder score between the two groups was statistically significant (P=0.04). For elbow joints, the average postoperative Mayo elbow performance score between these two approaches did not differ significantly.
Both the antegrade intramedullary nailing and the retrograde intramedullary nailing are good alternatives for the treatment of humeral shaft fractures. Because of higher incidence of iatrogenic fractures, the insertion point of retrograde intramedullary nailing should be carefully prepared. With antegrade insertion, it important to bury the humeral nail below the rotator cuff to prevent the subacromial impingement, and the rotator cuff should be carefully repaired to avoid shoulder pain and improve shoulder function.
比较顺行髓内钉与逆行髓内钉治疗肱骨干骨折的疗效。
1999年3月至2006年10月，105例肱骨干骨折患者采用带锁髓内钉治疗并获得充分随访。其中顺行髓内钉固定82例，逆行髓内钉固定23例。随访指标包括手术时间、出血量、骨折愈合率、愈合时间、并发症、Constant-Murley肩关节评分和Mayo肘关节功能评分。
平均随访时间31.2个月。顺行髓内钉固定的出血量明显少于逆行髓内钉固定（P = 0.002）。两组手术时间、并发症、愈合时间和骨折愈合率差异无统计学意义。顺行髓内钉组并发症包括4例骨不连、1例桡神经麻痹、8例肩部疼痛伴肩关节活动度减小。逆行髓内钉组并发症包括1例桡神经麻痹和3例医源性骨折。对于肩关节，两组平均Constant-Murley肩关节评分差异有统计学意义（P = 0.04）。对于肘关节，两种手术方式术后平均Mayo肘关节功能评分差异无统计学意义。
顺行髓内钉和逆行髓内钉都是治疗肱骨干骨折的良好选择。由于医源性骨折发生率较高，逆行髓内钉的进针点应仔细准备。顺行插入时，将肱骨髓内钉埋于肩袖下方以防止肩峰下撞击很重要，并且应仔细修复肩袖以避免肩部疼痛并改善肩部功能。
