Euler Simon A, Hengg Clemens, Boos Matthias, Dornan Grant J, Turnbull Travis Lee, Wambacher Markus, Kralinger Franz S, Millett Peter J, Petri Maximilian
Department of Trauma Surgery and Sports Traumatology, Medical University Innsbruck, Innsbruck, Austria; The Steadman Clinic, Vail, CO, USA; Steadman Philippon Research Institute, Vail, CO, USA.
Department of Trauma Surgery and Sports Traumatology, Medical University Innsbruck, Innsbruck, Austria.
J Shoulder Elbow Surg. 2017 May;26(5):902-908. doi: 10.1016/j.jse.2016.10.021. Epub 2017 Jan 19.
Straight antegrade intramedullary nailing of proximal humerus fractures has shown promising clinical results. However, up to 36% of all humeri seem to be "critical types" in terms of the potential violation of the supraspinatus (SSP) tendon footprint by the nail's insertion zone. The aims of this study were to evaluate if a computed tomography (CT) scan could reliably predict the nail's entry point on the humeral head and if it would be possible to preoperatively estimate the individual risk of iatrogenic violation of the SSP tendon footprint by evaluating the uninjured contralateral humerus.
Twenty matched pairs of human cadaveric shoulders underwent CT scans, and the entry point for an antegrade nail as well as measurements regarding critical distances between the entry point and the rotator cuff were determined. Next, gross anatomic measurements of the same data were performed and compared. Furthermore, specimens were reviewed for critical types.
Overall, 42.5% of all specimens were found to be critical types. The CT measurements exhibited excellent intra-rater and inter-rater reliability (intraclass correlation coefficients >0.90). Similarly, excellent agreement between the CT scan and gross anatomic measurements in contralateral shoulders (intraclass correlation coefficients >0.88) was found.
Assessing the uninjured contralateral side, CT can reliably predict the entry point in antegrade humeral nailing and preoperatively identify critical types of humeral heads at risk of iatrogenic implantation damage to the SSP tendon footprint. This study may help surgeons in the decision-making processon which surgical technique should be used without putting the patient at risk for iatrogenic, implant-related damage to the rotator cuff.
肱骨近端骨折的顺行髓内钉固定已显示出良好的临床效果。然而，就髓内钉插入区域可能侵犯冈上肌（SSP）肌腱足迹而言，所有肱骨中高达36%似乎属于“关键类型”。本研究的目的是评估计算机断层扫描（CT）能否可靠地预测髓内钉在肱骨头的进针点，以及是否有可能通过评估未受伤的对侧肱骨来术前估计医源性侵犯SSP肌腱足迹的个体风险。
对20对匹配的人体尸体肩部进行CT扫描，确定顺行髓内钉的进针点以及进针点与肩袖之间关键距离的测量值。接下来，对相同数据进行大体解剖测量并进行比较。此外，对标本进行关键类型的评估。
总体而言，所有标本中有42.5%被发现为关键类型。CT测量在同一评估者和不同评估者之间均表现出极好的可靠性（组内相关系数>0.90）。同样，在对侧肩部的CT扫描与大体解剖测量之间也发现了极好的一致性（组内相关系数>0.88）。
通过评估未受伤的对侧，CT能够可靠地预测肱骨顺行髓内钉固定的进针点，并在术前识别有医源性植入物损伤SSP肌腱足迹风险的关键类型肱骨头。本研究可能有助于外科医生在决策过程中选择合适的手术技术，而不会使患者面临医源性、与植入物相关的肩袖损伤风险。
