Hollister Anne M, Saulsbery Carla, Odom Jennifer L, Anissian Lucas, Garon Mark Tyson, Jordan Jenee'
Department of Orthopaedic Surgery, Louisiana State University Health Sciences Center, LA, USA.
Tech Hand Up Extrem Surg. 2011 Sep;15(3):138-43. doi: 10.1097/BTH.0b013e31820246ee.
Humeral shaft fracture intramedullary nailing is less invasive than plates and screws. Antegrade technique has postoperative shoulder pain, increased rehab time, and frequent reoperation for rod removal. Published retrograde technique is not collinear with the shaft, has insertion site fractures (5% to 15%), and radial nerve palsies (5%). Our retrograde technique is collinear with the humerus shaft, simpler, and decreases operative fracture risk. The supine patient's elbow is fully flexed. A guide pin is inserted through the triceps tendon to the olecranon fossa roof, aligned with the humerus shaft, and drilled thought the cortex followed by the 6.5 mm cannulated drill through a small triceps splitting incision. The guide pin is passed along the humerus shaft and across the fracture. A small incision is made to identify and protect the radial nerve during reduction, reaming, and rod insertion. Flexible reamers are used and the nail placed and locked at least distally to prevent distal migration. An institutional review broad approved retrospective review of Louisiana State University Health Sciences Center adult humeral shaft fractures with retrograde technique from 1999 to January of 2009 was carried out. Sixteen patients were treated without perioperative fracture or nerve palsy.
肱骨干骨折髓内钉固定术比钢板螺钉固定术的侵入性更小。顺行技术存在术后肩部疼痛、康复时间延长以及频繁进行取出髓内钉再手术的问题。已发表的逆行技术与骨干不共线，存在插入部位骨折（5%至15%）以及桡神经麻痹（5%）的情况。我们的逆行技术与肱骨干共线，操作更简单，且降低了手术骨折风险。仰卧位患者的肘部完全屈曲。通过三头肌腱插入一根导针至鹰嘴窝顶部，使其与肱骨干对齐，然后通过皮质钻孔，接着经一个小的三头肌劈开切口用6.5毫米空心钻钻孔。导针沿肱骨干穿过骨折部位。在复位、扩髓和插入髓内钉过程中，做一个小切口以识别和保护桡神经。使用柔性扩髓器，放置髓内钉并至少在远端锁定以防止远端移位。对路易斯安那州立大学健康科学中心1999年至2009年1月采用逆行技术治疗的成人肱骨干骨折进行了机构审查委员会批准的回顾性研究。16例患者接受治疗，未出现围手术期骨折或神经麻痹。
