Grossterlinden Lars, Ueblacker Peter, Rueger Johannes M
Department of Trauma, Hand, and Reconstructive Surgery, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.
Department of Trauma, Hand, and Reconstructive Surgery, University Medical Center Hamburg-Eppendorf, Martinistrasse 52, 20246, Hamburg, Germany.
Eur J Trauma Emerg Surg. 2007 Aug;33(4):383-7. doi: 10.1007/s00068-007-7088-3. Epub 2007 Jul 31.
Proximal humeral fractures represent up to five percent of all fractures in adults, commonly found in elderly patients. The final functional results after different operative procedures are among other factors dependent on whether or not a rotator cuff lesion is pre-existent, prior to the fracture, and how its surgical therapy is carried out. However, to what extent prior rotator cuff tears in this special patient group contribute to the functional outcome remains widely unclear. In our institution antegrade intramedullary nailing is the treatment of choice for proximal humeral fractures. One critical point of this technique is the unavoidable split of the rotator cuff on the approach to the proximal humerus and the insertion of the nail through the incised cuff. We report on a case of an impingement after antegrade intramedullary nailing of a proximal humeral fracture. Diagnostic glenohumeral arthroscopy revealed neither a residual lesion of the former rotator cuff incision nor a chondral lesion at the former insertion site of the nail. In the same session subacromial decompression and a nettoyage of adhesions were performed. We assume that splitting the rotator cuff for the insertion of an antegrade nail in a proximal humeral fracture is less relevant than previously assumed and described.
肱骨近端骨折占成人所有骨折的5%，常见于老年患者。不同手术方式后的最终功能结果除其他因素外，取决于骨折前是否存在肩袖损伤以及其手术治疗方式。然而，在这个特殊患者群体中，既往肩袖撕裂在多大程度上影响功能结果仍不清楚。在我们机构，顺行髓内钉固定术是肱骨近端骨折的首选治疗方法。该技术的一个关键点是在接近肱骨近端和通过切开的肩袖插入髓内钉时不可避免地会导致肩袖撕裂。我们报告一例肱骨近端骨折顺行髓内钉固定术后撞击的病例。诊断性肩关节镜检查未发现既往肩袖切口的残留病变，也未发现髓内钉先前插入部位的软骨损伤。在同一次手术中进行了肩峰下减压和粘连清理。我们认为，在肱骨近端骨折中为插入顺行髓内钉而切开肩袖的影响比之前认为和描述的要小。
