Department of Trauma and Reconstructive Surgery, Friederikenstift Hospital Hannover, Humboldtstraße 5, 30169, Hannover, Germany,
Arch Orthop Trauma Surg. 2012 May;132(5):641-7. doi: 10.1007/s00402-011-1430-2. Epub 2011 Nov 19.
The most criticism of antegrade humeral nailing is the potentially deleterious effect on the shoulder function, which is caused by the trauma to the M. supraspinatus (SSP) at the nail insertion site. We describe a new technique of all-arthroscopical intramedullary nailing, which preserves the rotator cuff, and compare it with the conventional open procedure.
From 11/2009 to 12/2010 82 patients with unstable, displaced proximal humeral fractures were treated surgically. Twenty-one of these patients received an intramedullary nailing. Sixteen of 21 met the inclusion criteria. Based on the surgeon's arthroscopic experience, patients were assigned to the arthroscopic (group I, n = 8) or open group (group II, n = 8). Both groups were compared due to the replacement results, complications, time of surgery and fluoroscopy. Concomitant intraarticular pathologies were assessed (group I). First clinical results after a median follow-up of 13 months (group I) and 14 months (group II) were reported.
Between group I and II, no significant differences were seen in patients age [77 years (range 45-90 years) vs. 76 years (range 65-92 years)], gender (6 female/2 male vs. 5 female/3 male) and fracture pattern (six 2-/two 3-part fractures vs. five 2-/three 3-part fractures). The reduction was evaluated by the caput-diaphysis-angle, which was median 137° (range 120-147°) in group I and 132° (range 120-158°) in group II (p = 0.959). Postoperatively, group I showed one varus-, group II two varus- and valgus deformities. Median time of surgery was 75 min (range 45-182 min) versus 70 min (range 40-146 min) (p = 0.442), fluoroscopy time 1.5 min (range, 0.6-3.7 min) versus 1.2 min (range 0.3-2.2 min) in group I and II (p = 0.336). Concomitant pathologies like one traumatic bicipital tendon-lesion and three partial lesions of the SSP were observed and treated in group I. Constant Scores and Visual Analogue Scale did not differ significantly between both groups at the time of follow-up.
All-arthroscopical humeral nailing is possible, preserves the rotator cuff and provides equal replacement and functional results like the open technique. An arthroscopically visualized optimal nail insertion point provides less frequent head deformities. Level of evidence Level III.
前向肱骨钉固定术最受批评的是对肩部功能的潜在有害影响，这是由于在钉插入部位对肩胛下肌（SSP）的创伤引起的。我们描述了一种新的全关节内髓内钉固定技术，它保留了肩袖，并将其与传统的开放手术进行比较。
自 2009 年 11 月至 2010 年 12 月，对 82 例不稳定、移位的肱骨近端骨折患者进行了手术治疗。其中 21 例接受髓内钉治疗。21 例中有 16 例符合纳入标准。根据外科医生的关节镜经验，患者被分配到关节镜组（I 组，n=8）或开放组（II 组，n=8）。由于置换结果、并发症、手术时间和透视，两组均进行了比较。评估了伴随的关节内病变（I 组）。报告了中位数随访 13 个月（I 组）和 14 个月（II 组）后的首次临床结果。
I 组和 II 组之间，患者年龄[77 岁（范围 45-90 岁）与 76 岁（范围 65-92 岁）]、性别（6 女/2 男与 5 女/3 男）和骨折类型（6 例 2/2 例 3 部分骨折与 5 例 2/3 例 3 部分骨折）无显著差异。I 组的复位通过头干角评估，中位数为 137°（范围 120-147°），II 组为 132°（范围 120-158°）（p=0.959）。术后，I 组有 1 例内翻畸形，II 组有 2 例内翻畸形和 1 例外翻畸形。手术时间中位数为 75 分钟（范围 45-182 分钟）与 70 分钟（范围 40-146 分钟）（p=0.442），透视时间中位数为 1.5 分钟（范围 0.6-3.7 分钟）与 1.2 分钟（范围 0.3-2.2 分钟）（p=0.336）。在 I 组中观察到并治疗了伴随的病变，如创伤性肱二头肌肌腱损伤和 3 例肩袖部分损伤。在随访时，两组的 Constant 评分和视觉模拟评分无显著差异。
全关节内肱骨钉固定术是可行的，保留了肩袖，并提供了与开放技术相同的置换和功能效果。关节镜下观察到的最佳钉插入点可减少头部畸形的发生。证据水平 III 级。
