Liebergall M, Jaber S, Laster M, Abu-Snieneh K, Mattan Y, Segal D
Hadassah University Hospital at Ein Kerem, Department of Orthopedic Surgery, Jerusalem, Israel.
Injury. 1997 Nov-Dec;28(9-10):577-80. doi: 10.1016/s0020-1383(97)00040-5.
From January 1987 to April 1993, 25 multiply injured patients were treated with closed intramedullary Ender nail fixation of the humeral shaft. Criteria for the procedure were humeral diaphyseal fractures with associated multiple injuries. Seventeen distal and mid-shaft fractures were treated via a modified anterograde approach in which the rotator cuff is not violated. Eight proximal third fractures were treated via the standard retrograde approach. Postoperative follow-up averaged 36 months. Full range of motion was attained 17 of the 25 patients. Of the eight remaining patients, three with a slightly limited range of motion achieved full range of motion following nail removal; three had preoperative radial nerve palsy which resolved within 1 year, and two patients required follow-on plating. In 92 per cent (23 of 25) there were no incidences of infection or non-union. Flexible nails avoid complications of reaming. The modified anterograde approach allows excellent shoulder motion since it does not violate the rotator cuff. Ender nails provide excellent fixation and clinical outcome in the multiply injured patient and are cost effective compared with interlocking nails.
1987年1月至1993年4月，对25例多处受伤患者采用闭合式肱骨骨髓内Enders钉固定治疗肱骨干骨折。该手术的标准是肱骨干骨折合并多处损伤。17例中、下段骨折采用改良顺行入路治疗，该入路不损伤肩袖。8例近段三分之一骨折采用标准逆行入路治疗。术后平均随访36个月。25例患者中有17例达到了全关节活动范围。其余8例患者中，3例活动范围略受限的患者在取出钉子后达到了全关节活动范围；3例术前有桡神经麻痹，1年内恢复；2例患者需要后续钢板固定。92%（25例中的23例）无感染或骨不连发生。弹性钉可避免扩髓的并发症。改良顺行入路不损伤肩袖，可使肩部活动良好。Enders钉在多处受伤患者中提供了良好的固定和临床效果，与交锁髓内钉相比，成本效益更高。
