交锁髓内钉顺行和逆行置入治疗肱骨干骨折:18例优劣比较

Antegrade intramedullary nailing versus retrograde intramedullary nailing for humeral shaft fracture in 18 cases

背景:交锁髓内钉治疗肱骨干骨折避免了因钢板置入而导致的应力遮挡和桡神经损伤等并发症,符合现代微创骨科的观点,是一种生物学内固定方法。目的:探讨顺行和逆行置入交锁髓内钉治疗肱骨干骨折的临床意义。方法:采用Russell-Taylor交锁髓内钉治疗18例肱骨骨折,其中顺行置钉10例,逆行置钉8例。术后定期行X射线片检查和肩关节功能评价。结果与结论:获得随访14例,顺行置钉8例,逆行置钉6例,随访时间8～15个月。14例均获骨性愈合,愈合时间3～9个月。顺行置钉肩关节功能:优5例,良2例,可1例;逆行置钉肩关节功能:优5例,良1例。顺行和逆行置入交锁髓内钉都可用于肱骨干骨折的治疗,具有减少桡神经损伤,减少创伤,固定牢靠等优点,顺行置钉易致肩袖损伤,逆行置钉因需开长槽,易致骨质劈裂,故临床上选择何种方式,需具体情况具体分析。

BACKGROUND： Intramedullary nailing in treatment of humeral shaft fractures prevents plate implantation-induced stress shield or radial nerve injury, and accords with modern minimally invasive orthopedics. It has become a biological internal fixation method. OBJECTIVE： To compare the effectiveness between antegrade and retrograde intramedullary nailing for the treatment of humeral shaft fractures. METHODS： A total of 18 patients with humeral shaft fractures were treated with Russell-Taylor nail, including 10 antegrade nailing and 8 retrograde nailing. The shoulder function was evaluated using X-ray examination. RESULTS AND CONCLUSION： A total of 14 patients were followed-up for 8-15 months, including 8 of antegrade nailing and 6 of retrograde nailing. The shoulder function was excellent in 5 cases, good in 2 cases and fair in 1 case undergoing antegrade nailing; excellent in 5 and good in 1 undergoing retrograde nailing. Antegrade and retrograde nailing have similar treatment results, which reduce radial nerve injury, decrease trauma, and fix well. However, antegrade nailing can injury rotator cuff, and retrograde nailing may lead to bone breakage. Therefore, they may be good alternatives for the treatment of humeral shaft fractures according to the condition of patients.