Hoffmann R, Khodadadyan C, Raschke M, Melcher I, Maitino P D, Haas N P
Unfall- und Wiederherstellungschirurgie, Humboldt-Universität zu Berlin.
Zentralbl Chir. 1998;123(11):1232-8.
Retrograde intramedullary fixation of proximal humerus fractures with flexible wires was evaluated in a prospectively documented study. Seventy-four fractures in 73 patients with unstable proximal humerus shaft or neck fractures were fixed with 3-11 flexible intramedullary wires. The age of the patients averaged 72 years (42 females, 31 males). In nine fractures additional implants (screws, cerclages) were used to fix dislocated fragments through an anterior approach to the shoulder. Complications associated with the procedure especially in osteoporotic bone were secondary loss of reduction (16%) and wire migration (21%) which lead to revision surgery in 14% of patients within 6 weeks. A minimum follow-up of 12 months (average 16.5 months) could be obtained in 61 patients (84%). According to the Neer- and Constant-scores 60% showed good or excellent results, 30% had a satisfactory and 10% had an unsatisfactory or poor result.--Retrograde intramedullary, flexible wire fixation can provide an overall satisfactory outcome in unstable proximal humerus fractures of the elderly. However, the high incidence of secondary wire dislocations especially in marked osteoporosis appears to be an unsolved problem of this treatment modality.
在一项前瞻性记录研究中，对使用弹性髓内钉逆行固定肱骨近端骨折进行了评估。73例不稳定型肱骨干或肱骨近端骨折患者的74处骨折，采用3至11根弹性髓内钉进行固定。患者平均年龄72岁（女性42例，男性31例）。9处骨折通过肩部前方入路使用额外的植入物（螺钉、环扎带）固定脱位的骨折块。与该手术相关的并发症，尤其是在骨质疏松性骨中，复位丢失（16%）和髓内钉移位（21%），导致14%的患者在6周内进行了翻修手术。61例患者（84%）获得了至少12个月的随访（平均16.5个月）。根据Neer评分和Constant评分，60%的患者结果为良好或优秀，30%的患者结果满意，10%的患者结果不满意或较差。——逆行弹性髓内钉固定术在老年不稳定型肱骨近端骨折中可提供总体满意的结果。然而，尤其是在明显骨质疏松的情况下，髓内钉继发脱位的高发生率似乎是这种治疗方式尚未解决的问题。
