新一代直肱骨钉可实现更快的骨愈合和更好的中期功能结果。
Newer generation straight humeral nails allow faster bone healing and better functional outcome at mid-term.
机构信息
Orthopedic Institute, Fondazione Policlinico Universitario A. Gemelli IRCCS - Università Cattolica del Sacro Cuore, Largo Agostino Gemelli n°8, Rome, Italy.
出版信息
J Orthop Surg Res. 2021 Oct 20;16(1):631. doi: 10.1186/s13018-021-02776-w.
PURPOSE
Although proximal and diaphyseal humerus fractures are frequent, the optimal management remains controversial. Antegrade nailing prevents further damage to the soft tissues and to the vascularization, but it has been associated with postoperative shoulder pain and dysfunction. During the latest years a straight nail design was developed to minimize these problems.
METHODS
A total of 243 patients who had undergone surgery for antegrade intramedullary humeral nailing between January 2013 and July 2018 in A. Gemelli Trauma Center were divided into two groups according to the nail design used: straight nail group (S-group) and curvilinear nail group (C-group). Clinical data were collected using assessment forms (SF12-v2, Quick-DASH, ASES and Constant-Murley). Radiographic bone healing was assessed with RUST score at 30, 90 and 180 days after surgery.
RESULTS
The S-group was made up of 128 patients with a mean age of 59 ± 19 (range 18-97) and a mean follow-up of 46 ± 9 months. The C-group was made up of 115 patients with a mean age of 53 ± 16 (range 18-88) and a mean follow-up of 51 ± 8 months. The S-group had a mental component summary (MCS) score of 54.3 ± 7.7 and a physical component summary (PCS) score of 46 ± 10.2, the C-group had a MCS score of 50.9 ± 8.4 and a PCS score of 44.1 ± 7.4. Quick-DASH and ASES were respectively 18.8 ± 4.3 and 78.6 ± 8.2 in the S-group, 28.3 ± 11.6 and 72.1 ± 13.5 in the C-group with statistical significance. Constant-Murley score was 73.9 ± 9.1 in the S-group (76% of the contralateral healthy side) and 69.4 ± 10.4 in the C-group (73% of the contralateral healthy side). The radiographic union score in the S-group was 4.1 ± 0.3 at 30 days after surgery, 7 ± 0.8 at 90 days and 10 ± 1.2 at 180 days, while in the C-group it was 4.2 ± 0.4 at 30 days, 6.4 ± 0.7 at 90 days and 9 ± 0.9 at 180 days.
CONCLUSION
Newer generation straight nails allow a faster bone healing and better functional outcome at mid-term follow up. Level of evidence III.
目的
尽管肱骨近端和骨干骨折较为常见，但最佳治疗方法仍存在争议。顺行髓内钉固定可防止软组织和血供进一步受损，但与术后肩部疼痛和功能障碍有关。近年来，直钉设计的发展旨在最小化这些问题。
方法
2013 年 1 月至 2018 年 7 月期间，在 A. Gemelli 创伤中心接受顺行髓内钉治疗的 243 例肱骨骨折患者，根据使用的钉设计分为两组：直钉组（S 组）和曲线钉组（C 组）。使用评估表（SF12-v2、Quick-DASH、ASES 和 Constant-Murley）收集临床数据。术后 30、90 和 180 天使用 RUST 评分评估骨愈合情况。
结果
S 组 128 例，平均年龄 59±19 岁（18-97 岁），平均随访 46±9 个月。C 组 115 例，平均年龄 53±16 岁（18-88 岁），平均随访 51±8 个月。S 组的精神健康分量表（MCS）评分为 54.3±7.7，生理健康分量表（PCS）评分为 46±10.2；C 组的 MCS 评分为 50.9±8.4，PCS 评分为 44.1±7.4。S 组的 Quick-DASH 和 ASES 分别为 18.8±4.3 和 78.6±8.2，C 组为 28.3±11.6 和 72.1±13.5，差异有统计学意义。S 组的 Constant-Murley 评分为 73.9±9.1（患侧健侧的 76%），C 组为 69.4±10.4（患侧健侧的 73%）。S 组术后 30 天的影像学愈合评分（RUST）为 4.1±0.3，90 天为 7±0.8，180 天为 10±1.2；C 组分别为 4.2±0.4、6.4±0.7 和 9±0.9。
结论
新一代直钉可在中期随访时更快地促进骨愈合和获得更好的功能结果。证据等级 III。
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