Tyllianakis Minos, Tsoumpos Pantelis, Anagnostou Kostas, Konstantopoulou Anna, Panagopoulos Andreas
Department of Shoulder and Elbow Surgery, University Hospital of Patras, Rio, Greece.
Int J Shoulder Surg. 2013 Apr;7(2):65-9. doi: 10.4103/0973-6042.114233.
Distal interlocking is regarded as an inherent part of the antegrade humeral nailing technique, but it exposes both the patient and surgeon to radiation, is time consuming, and has a potential risk of damaging neurovascular structures. We have presented our technique of diaphyseal humeral nailing without any distal interlocking in this paper.
We have presented a series of 64 consecutive patients (33 male and 31 female, mean age: 41.5 years) with humeral shaft fractures treated with antegrade rigid intramedullary nailing without distal interlocking following a strict intra and postoperative protocol. According to the AO classification, there were 36 type A fractures, 22 type B, and 6 type C. Nails were inserted unreamed or by using limited proximal reaming and they were fitted as snuggly as possible into the medullary canal. After impaction of the nail into the fossa, we carefully tested rotational stability of fixation by checking any potential external rotation when the arm was slightly turned externally and left to the gravity forces. We were ready to add distal screws, but that was not required in these cases. Follow-up assessment included fracture union, complications and failures, and the final clinical outcome at minimum 2-year follow-up using the parameters of the constant score.
All fractures, except two, united between the 4(th) and 5(th) postoperative month. In one case, nail was exchanged with plate, and, in another, a larger nail was used at a second surgery. Shoulder function according to constant score, at a minimum of 2-year follow-up, was excellent or very good in 93.7% of the patients.
Provided that some technical issues are followed, the method reduces intraoperative time and radiation exposure and avoids potential damage to neurovascular structures.
远端交锁被视为顺行肱骨髓内钉技术的固有组成部分，但它会使患者和外科医生都暴露于辐射之下，耗时且有损伤神经血管结构的潜在风险。在本文中，我们介绍了不进行任何远端交锁的肱骨干髓内钉技术。
我们报告了连续64例肱骨干骨折患者（33例男性，31例女性，平均年龄：41.5岁），按照严格的术中和术后方案接受了无远端交锁的顺行刚性髓内钉治疗。根据AO分类，有36例A型骨折，22例B型骨折和6例C型骨折。髓内钉插入时不扩髓或仅近端有限扩髓，并尽可能紧密地贴合髓腔。将髓内钉打入髓腔后，我们通过在手臂略向外旋转并任其受重力作用时检查是否有任何潜在的外旋来仔细测试固定的旋转稳定性。我们准备好添加远端螺钉，但在这些病例中不需要。随访评估包括骨折愈合、并发症和失败情况，以及使用Constant评分参数在至少2年随访时的最终临床结果。
除2例骨折外，所有骨折均在术后第4至5个月愈合。1例患者将髓内钉更换为钢板，另1例在二次手术时使用了更大的髓内钉。在至少2年的随访中，根据Constant评分，93.7%的患者肩部功能为优或良。
只要遵循一些技术要点，该方法可减少手术时间和辐射暴露，并避免对神经血管结构的潜在损伤。
