Strohm P C, Kubosch D C, Hübner E J, Südkamp N P, Jaeger M, Reising K
Department Orthopädie und Traumatologie, Klinikum der Albert-Ludwigs-Universität Freiburg, Deutschland.
Chirurg. 2011 Oct;82(10):947-54; quiz 955. doi: 10.1007/s00104-010-2055-7.
Fractures of the humeral shaft are less frequent than those of the proximal humerus. The formerly recommended treatment of humeral shaft fractures was conservative according to Böhler. This still remains an adequate concept of treatment but according to a change in the technical possibilities and the demands of patients and physicians on fast restoration of function and low pain, there is a trend towards surgical stabilization of humeral shaft fractures. The implant of choice is discussed controversially and consists of various types of nails versus plating. The technique of nailing is antegrade or retrograde and depends on the localization of the fracture. In our opinion good indications for plating are combined fractures of the proximal humerus and the shaft as well as very distal humeral shaft fractures. A primary lesion of the radial nerve is no imperative indication for exploration and different studies have shown the same results for exploration after 2 or 3 months if there is no spontaneous remission.
肱骨干骨折比肱骨近端骨折少见。以前,按照博勒尔的观点,肱骨干骨折推荐的治疗方法是保守治疗。这仍然是一种恰当的治疗理念,但鉴于技术可能性的变化以及患者和医生对快速恢复功能和低疼痛的要求,目前存在对肱骨干骨折进行手术固定的趋势。对于首选植入物存在争议,包括各种类型的髓内钉与钢板。髓内钉技术有顺行和逆行之分,这取决于骨折的部位。我们认为,钢板固定的良好适应证是肱骨近端与骨干的合并骨折以及肱骨干极远端骨折。桡神经的原发性损伤并非必须进行探查的指征,并且不同研究表明,如果没有自发恢复,在2或3个月后进行探查会得到相同的结果。