Contreras Julio J, Meissner Arturo, Valenzuela Alfonso, Liendo Rodrigo, de Marinis Rodrigo, Calvo Claudio, Soza Francisco
Shoulder and Elbow Unit, Pontifical Catholic University of Chile, Santiago, Chile.
Department of Orthopedics and Trauma, Pontifical Catholic University of Chile, Santiago, Chile.
Shoulder Elbow. 2023 Nov;15(4 Suppl):72-80. doi: 10.1177/17585732221150895. Epub 2023 Jan 12.
Straight antegrade humeral nailing (SAHN) is associated with excellent clinical results in proximal humerus fractures. The optimal entry point is the top of the humeral head. However, the anatomy is variable, and the entry point can affect supraspinatus tendon footprint (SSP-F) or fracture reduction. The aim of this study was to analyze the relationship between the SSP-F and SAHN entry point by analyzing magnetic resonance imaging (MRI) studies of the humerus.
In total 58 MRI studies of entire humerus were reviewed. The mean age was 51.6 ± 12.4 years, with 40 female patients. The distance between the SSP-F and the SAHN insertion point (critical distance: CD), the width of the footprint, and the neck-shaft angle (NSA) were measured. Univariate and multivariate analysis were performed.
The mean CD was 7.51 mm ± 2.81 (0-12.9 mm) with 51.7% of proximal humerus "critical type" (CD <8 mm). The CD was found to be lower in females, with no difference found with varying age (62.5% "critical type"). CD correlated with NSA (linear regression). "Critical type" correlated with female gender and NSA (logistic regression).
More than half of the humerus are "critical types" as to SAHN and may, therefore, be at risk for procedure-related complications.
肱骨顺行髓内钉固定术（SAHN）治疗肱骨近端骨折临床效果良好。最佳进针点为肱骨头顶点。然而，解剖结构存在个体差异，进针点可能影响冈上肌腱附着点（SSP-F）或骨折复位。本研究旨在通过分析肱骨的磁共振成像（MRI）研究，分析SSP-F与SAHN进针点之间的关系。
共回顾了58例完整肱骨的MRI研究。平均年龄为51.6±12.4岁，女性患者40例。测量了SSP-F与SAHN进针点之间的距离（临界距离：CD）、附着点宽度和颈干角（NSA）。进行了单因素和多因素分析。
平均CD为7.51 mm±2.81（0-12.9 mm），51.7%的肱骨近端为“临界类型”（CD<8 mm）。发现女性的CD较低，不同年龄组之间无差异（62.5%为“临界类型”）。CD与NSA相关（线性回归）。“临界类型”与女性性别和NSA相关（逻辑回归）。
超过一半的肱骨对于SAHN属于“临界类型”，因此可能存在与手术相关并发症的风险。
