Department of Trauma and Reconstructive Surgery, University of Rostock, Schillingallee 35, 18057, Rostock, Germany.
Arch Orthop Trauma Surg. 2010 May;130(5):687-91. doi: 10.1007/s00402-009-0956-z. Epub 2009 Aug 13.
Antegrade nailing allows a stable fixation and, thus, an early functional after treatment in proximal humerus fractures. Since the surgical procedure in antegrade humeral nailing requires a split of the supraspinatus tendon, the question arises whether the surgical approach causes microcirculatory dysfunction of the tendon.
A total of 15 consecutive patients suffering from proximal humerus fractures were enrolled. During the implantation of an antegrade humerus nail, microvascular perfusion of the supraspinatus tendon was directly visualized after the exposition and stabilization of the fracture using the OPS-imaging technique.
Immediately after exposure, the nutritive perfusion showed physiological values of tendon microcirculation. After implanting antegrade humeral nails, the perfusion of the supraspinatus tendon reduced markedly. Capillary width was unaffected by the surgical procedure.
The trauma leading to proximal humerus fracture causes no fundamental impairment of nutritive perfusion of the rotator cuff. Whereas the implantation of an antegrade humerus nail, which necessarily includes a splitting of the rotator cuff, nearly halves the functional capillary density of the supraspinatus tendon. Even though this effect seems to be reversible, the surgical dissection of the supraspinatus tendon should be performed in a soft tissue sparing way.
顺行髓内钉固定可提供稳定的固定，从而在治疗肱骨近端骨折后早期实现功能。由于顺行肱骨髓内钉固定术需要劈开冈上肌腱，因此出现了一个问题，即手术入路是否会导致肌腱的微循环功能障碍。
共纳入 15 例连续的肱骨近端骨折患者。在使用 OPS 成像技术暴露和稳定骨折的过程中，直接观察顺行肱骨髓内钉植入过程中冈上肌腱的微血管灌注。
暴露后，营养灌注显示出肌腱微循环的生理值。在植入顺行肱骨髓内钉后，冈上肌腱的灌注明显减少。毛细血管宽度不受手术过程的影响。
导致肱骨近端骨折的创伤不会对肩袖的营养灌注造成根本损害。而植入顺行肱骨髓内钉必然会导致肩袖撕裂，几乎使冈上肌腱的功能性毛细血管密度减半。尽管这种影响似乎是可逆的，但仍应采用软组织保护的方式进行冈上肌腱的手术分离。
