Department of Orthopedic Surgery, Duke University Medical Center, Durham, NC, USA.
Department of Orthopedic Surgery, Duke University Medical Center, Durham, NC, USA.
J Shoulder Elbow Surg. 2021 Apr;30(4):747-755. doi: 10.1016/j.jse.2020.07.044. Epub 2020 Aug 19.
Antegrade humeral intramedullary nails are an effective fixation method for certain proximal humeral fractures and humeral shaft fractures. However, owing to potential rotator cuff damage during nail insertion, shoulder pain remains a common postoperative complaint. The purpose of this study was to provide quantitative data characterizing the anatomic and radiographic location of the rotator interval (RI) for an antegrade humeral intramedullary nail using a mini-deltopectoral approach.
Six consecutive fresh-frozen intact cadaveric specimens (mean age, 69 ± 12.8 years) were obtained for our study. Demographic data were collected on each specimen. A mini-deltopectoral approach was used, followed by placement of a guidewire in the RI. Quantitative anatomic relationships were calculated using a fractional carbon fiber digital caliper. Radiographic measurements were performed by 2 orthopedic residents and 1 practicing fellowship-trained orthopedic surgeon. In addition to re-measurement of similar anatomic relationships on radiographs, the ratio of the distance from the lateral humeral edge to the starting point relative to the width of the humeral head on the anteroposterior (AP) view was calculated. Similarly, on the lateral view, the ratio of the distance from the anterior humeral edge to the starting point relative to the humeral head width was calculated.
In all cases, the described approach allowed for preservation of the biceps tendon and access to the RI for guidewire insertion, with no subsequent rotator cuff or humeral articular cartilage damage identified following nail insertion. The ratio of the distance from the lateral humeral edge to the starting point relative to the humeral head width on the AP view was 0.4 ± 0.0. The ratio of the distance from the anterior humeral edge to the starting point relative to the humeral head width on the lateral view was 0.3 ± 0.0.
This study demonstrates the clinical feasibility of a mini-deltopectoral approach and shows that the ideal starting point through the RI radiographically lies along the medial aspect of the lateral third of the humeral head on the AP view and along the posterior aspect of the anterior third of the humeral head on the lateral view.
顺行肱骨髓内钉是治疗某些肱骨近端骨折和肱骨干骨折的有效固定方法。然而，由于在插入钉时可能会损伤肩袖，肩部疼痛仍然是常见的术后投诉。本研究的目的是提供使用小三角肌入路的顺行肱骨髓内钉的旋转间隔（RI）的解剖和影像学位置的定量数据。
我们的研究共使用了 6 个连续的新鲜冷冻完整尸体标本（平均年龄 69±12.8 岁）。收集了每个标本的人口统计学数据。使用小三角肌入路，然后在 RI 中放置导丝。使用分数碳纤维数字卡尺计算定量解剖关系。由 2 名骨科住院医师和 1 名有经验的骨科 fellowship培训医师进行放射学测量。除了在 X 线上重新测量类似的解剖关系外，还计算了从外侧肱骨缘到起点相对于肱骨头宽度的前后视图（AP）上的距离与比例。同样，在侧视图上，计算了从前肱骨缘到起点相对于肱骨头宽度的距离与比例。
在所有情况下，所描述的方法均允许保留二头肌肌腱并进入 RI 以插入导丝，在插入钉后未发现随后的肩袖或肱骨关节软骨损伤。在 AP 视图上，从外侧肱骨缘到起点相对于肱骨头宽度的距离与比例为 0.4±0.0。在侧视图上，从前肱骨缘到起点相对于肱骨头宽度的距离与比例为 0.3±0.0。
本研究证明了小三角肌入路的临床可行性，并表明 RI 影像学上的理想起点沿肱骨头外侧三分之一的内侧在 AP 视图上，沿肱骨头前三分之一的后在侧视图上。
