Gerich Torsten, Mouton Caroline, Jabbarian Lea, Weydert Jean-Paul, Hoffmann Alexander, Pape Dietrich, Seil Romain
Department of Orthopaedic Trauma, Centre Hospitalier de Luxembourg, 4, rue Barble, L-1210, Luxembourg, Luxembourg.
Department of Orthopaedic Surgery, Centre Hospitalier de Luxembourg, 76 rue d'Eich, L-1460, Luxembourg, Luxembourg.
J Exp Orthop. 2020 Feb 29;7(1):8. doi: 10.1186/s40634-020-00222-0.
The objective of this retrospective non-randomized study was to evaluate the portal of Neviaser (PN) as an alternative approach in antegrade humeral nailing.
The surgical approach for the straight antegrade intramedullary nail (SAIN) was either the anterolateral delta-split (group 2, n = 79) or the portal of Neviaser (group 3, n = 27). Length of surgery and time of radiation were extracted from charts. Patients stabilized using the PN were followed for a clinical and radiological exam. At follow-up we evaluated the DASH (Disability of the Arm, Shoulder and Hand) and CMS (Constant-Murley Score).
Between 10.2015 and 12.2018 191 proximal and diaphyseal humeral fractures were operated using either an angular stable extramedullary device (group 1, PHILOS®, n = 85) or a straight humeral nail (MultiLoc®, n = 106). Time of radiation and intervention followed a normal distribution. The mean length of surgery was 172.9 min (SD 91.5) in group 1, 121.5 min (SD 54.1) in group 2 and 96.4 min (SD 33.7) in group 3 (p < 0.01). Time of radiation was significantly different with 1.1 min (SD 0.6: group 1), 3.1 min (SD 1.6: group 2) and 2.9 min (SD 1.7: group 3) (p < 0.01). After a mean interval of 21.5 months (range 6-43 months) 14 / 27 patients of group 3 were available for a clinical and radiological follow-up. The mean DASH in group 3 was 25, the CMS reached 70. The age and sex weighted CMS mean value was 96%. Forward flexion was 131°, abduction 125°. The ratio of strength affected versus non-affected side was 4.4: 6.2 kg.
The portal of Neviaser is a feasible and safe approach and is an alternative to the anterolateral delta-split. Length of surgery and time of radiation were significantly shorter.
IV.
本回顾性非随机研究的目的是评估内维亚泽入路（PN）作为顺行肱骨交锁髓内钉置入术的一种替代方法。
对于直型顺行髓内钉（SAIN），手术入路采用前外侧三角肌劈开入路（第2组，n = 79）或内维亚泽入路（第3组，n = 27）。从病历中提取手术时间和透视时间。对采用PN入路固定的患者进行临床和影像学检查随访。随访时，我们评估了上肢、肩部和手部功能障碍评分（DASH）和Constant-Murley评分（CMS）。
在2015年10月至2018年12月期间，191例肱骨近端和骨干骨折患者接受了手术，其中采用角稳定型髓外固定装置（第1组，PHILOS®，n = 85）或直型肱骨髓内钉（MultiLoc®，n = 106）。透视时间和手术时间呈正态分布。第1组的平均手术时间为172.9分钟（标准差91.5），第2组为121.5分钟（标准差54.1），第3组为96.4分钟（标准差33.7）（p < 0.01）。透视时间有显著差异，第1组为1.1分钟（标准差0.6），第2组为3.1分钟（标准差1.6），第3组为2.9分钟（标准差1.7）（p < 0.01）。平均随访间隔21.5个月（范围6 - 43个月）后，第3组的27例患者中有14例接受了临床和影像学随访。第3组的平均DASH评分为25分，CMS评分为70分。年龄和性别加权后的CMS平均值为96%。前屈角度为131°，外展角度为125°。患侧与健侧力量比为4.4:6.2千克。
内维亚泽入路是一种可行且安全的方法，可作为前外侧三角肌劈开入路的替代方法。手术时间和透视时间明显更短。
IV级
