Blum J, Rommens P M
Klinik und Poliklinik für Unfallchirurgie, Joh. Gutenberg Universität Mainz, Germany.
Acta Chir Belg. 1997 Oct;97(5):237-43.
Open fractures, transverse, short oblique and spiroid fractures of the humeral shaft, as well as comminuted fractures with radial palsy or vascular injury, mostly lead to bad end-results if treated conservatively. The same is valid in the case of bilateral humeral shaft fractures, multiple injuries, polytrauma, pathologic fractures and pseudarthrosis. Good end-results and a low rate of complications in the operative procedure require an adequate approach to the fractured limb as well as a meticulous care of the soft tissues. In plate osteosynthesis, the anterolateral approach for the proximal third of the shaft, the anterolateral approach with radial exposure for the middle third of the shaft and the posterior approach for the distal third of the shaft seem to offer the best pathway for reposition and fixation, respecting the biologic requirements for a successful osteosynthesis. The approaches for external fixation demand a thorough knowledge of the course of the axillary and radial nerves. Unreamed intramedullary nailing can be done in an anterograde and in a retrograde way. In anterograde nailing, damage of the rotator cuff must be avoided, in retrograde nailing, the elbow capsule should be left closed and untouched.
肱骨干开放性骨折、横行骨折、短斜形骨折和螺旋形骨折，以及伴有桡神经麻痹或血管损伤的粉碎性骨折，若采用保守治疗，大多会导致不良的最终结果。双侧肱骨干骨折、多发伤、多处创伤、病理性骨折和假关节的情况亦是如此。手术过程中要想获得良好的最终结果并降低并发症发生率，就需要对骨折肢体采取恰当的入路方式，并精心护理软组织。在钢板内固定术中，对于肱骨干近端三分之一采用前外侧入路，对于中段三分之一采用暴露桡神经的前外侧入路，对于远端三分之一采用后外侧入路，似乎能为复位和固定提供最佳途径，同时满足成功进行骨合成的生物学要求。外固定的入路需要对腋神经和桡神经的走行有透彻的了解。非扩髓髓内钉固定可采用顺行和逆行两种方式。顺行髓内钉固定时，必须避免损伤肩袖；逆行髓内钉固定时，应保持肘关节囊闭合且不受触碰。
