Tsourvakas Stefanos, Alexandropoulos Christos, Papachristos Ioannis, Tsakoumis Grigorios, Ameridis Nikolaos
Orthopaedic Department, General Hospital of Trikala, 9, Dorotheou str, 42100 Trikala, Greece.
Musculoskelet Surg. 2011 Dec;95(3):193-8. doi: 10.1007/s12306-011-0126-7. Epub 2011 Apr 5.
Antegrade interlocked humeral nailing for stabilization of humeral fractures was introduced many years ago, and studies on this method in the orthopedic literature have shown mixed results. The purpose of this investigation was to document the clinical outcome and complications associated with the use of an antegrade intramedullary nail (T2, Stryker) for the humeral fractures. Between 2005 and 2008, 52 fractures of the humeral shaft were treated operatively with this intramedullary nail in our department. Eight patients were polytraumatized, and four patients had an open fracture. The mean age of patients was 51.7 years. Forty-eight patients had an adequate duration of clinical follow-up (a mean of 18 months) for analysis. Complications were recorded, and the time to union was measured. Shoulder and elbow functions were assessed using the Constant Score and the Morrey Score, respectively. Forty-six fractures healed, with a mean time to clinical union of 10.3 weeks. Two patients developed pseudarthroses. There were four adverse events: two proximal screws backed out, one superficial infection at the insertion point, and one fracture at the distal end of the nail. Ninety-one percentage of patients had an excellent or good shoulder function. Five further operations were necessary: two for treatment of pseudarthroses, two for removal the backed out proximal screws, and one wound debridement for superficial infection. Antegrade humeral nailing is a valid therapeutic option for stabilization of humeral shaft fractures. By strictly adhering to the operation technique, the number and the severity of complications can be reduced. When good fracture alignment and stability are obtained, uneventful bone healing with good functional results is the rule.
多年前就已引入顺行交锁肱骨钉固定肱骨骨折的方法，骨科文献中关于该方法的研究结果不一。本研究的目的是记录使用顺行髓内钉（T2，史赛克公司）治疗肱骨骨折的临床结果及并发症。2005年至2008年期间，我科使用该髓内钉对52例肱骨干骨折进行了手术治疗。8例患者为多发伤，4例患者为开放性骨折。患者的平均年龄为51.7岁。48例患者获得了足够长的临床随访时间（平均18个月）用于分析。记录并发症情况，并测量骨折愈合时间。分别使用Constant评分和Morrey评分评估肩部和肘部功能。46例骨折愈合，临床愈合的平均时间为10.3周。2例患者发生骨不连。有4例不良事件：2枚近端螺钉退出，1例在置入点出现浅表感染，1例在髓内钉远端发生骨折。91%的患者肩部功能为优或良。还需要进行5次进一步手术：2次用于治疗骨不连，2次用于取出退出的近端螺钉，1次用于对浅表感染进行伤口清创。顺行肱骨钉固定术是稳定肱骨干骨折的一种有效治疗选择。严格遵守手术技术可减少并发症的数量和严重程度。当获得良好的骨折对线和稳定性时，骨折顺利愈合并取得良好功能结果是通常的情况。
