背景:在活动患者中,移位的肱骨干骨折通常通过接骨术进行治疗。我们旨在评估Neviaser方法在侧位进行髓内钉(IMN)的结果,并将其与标准位置和常规方法进行IMN钉的结果进行比较。
方法:在回顾性评估中,单中心研究,我们比较了20例长IMN在侧卧位肱骨干近端或中三分之一骨折(Multilock;SynthesLaboratory)与经皮Neviaser入路在标准位置的IMN52例。患者的平均年龄为62+/-21岁。分析临床结果:常数评分,肩关节主观评价(SSV)评分和活动范围(ROM)。射线照相,进入点在肱骨近端,评估了治愈率以及临界肩角(CSA)与指甲正确定位之间的可能关联。
结果:平均随访26+/-2个月,在整个系列中,治愈率为89%(64/72),(不愈合的8名患者),2组间无差异。总体平均活动期前抬高(AAE)为125+/-22度,平均外旋(ER1)为35+/-17度,平均内旋(IR)在L3。平均Constant评分为58+/-23,SSV评分为73+/-12%。侧位组的ROM优于标准位置组(AAE133/-17vs122/-23,p=0.03;ER147/-13vs30/-16,p<0.001;IRT12vsL5,p=0.02)。与标准位置组相比,指甲在外侧突出的频率较低(1/20[5%]vs20/52[38.5%],p=0.002)。从前后视图看,指甲的位置更好(指甲居中:16/20[75%]vs26/52[50%],p=0.047)和侧视图(钉中心:18/20[90%]vs34/52[65.4%],p=0.02)在侧位比标准位组。我们发现指甲位置之间没有关联,方法类型和CSA。
结论:在短期随访中,通过在外侧位置使用长IMN与Neviaser入路进行肱骨干骨折的骨合成是一种可靠的技术。钉子的定位,特别是它的切入点,侧卧位和Neviaser入路的临床效果优于标准体位和常规入路。对更多患者的进一步研究,学习曲线的评估,并且需要分析该技术对合并症(脑灌注未改变)的影响,以充分验证该技术。
BACKGROUND: Displaced humeral shaft fractures are frequently treated by osteosynthesis in the active patient. We aimed to evaluate the results of intramedullary nailing (IMN) in the lateral position with the Neviaser approach and to compare them with those from IMN nailing in the standard position and conventional approach.
METHODS: In the retrospectively evaluated, single-center study, we compared 20 cases of long IMN for fractures of the proximal or middle third of the humerus shaft (Multilock; Synthes Laboratory) in the lateral position with the percutaneous Neviaser approach with 52 cases of IMN in the standard position. The mean age of patients was 62 ± 21 years. Clinical outcomes were analyzed: Constant score, subjective shoulder evaluation score and range of motion. Radiographically, entry point at the proximal part of the humerus, the healing rate and the possible association between the critical shoulder angle (CSA) and the correct positioning of the nail were assessed.
RESULTS: With a mean follow-up of 26 ± 2 months, the healing rate was 89% (64/72) in the overall series, (eight patients in non-union), with no difference between the two groups. The overall mean active anterior elevation (AAE) was 125 ± 22°, mean external rotation (ER1) was 35 ± 17°, and mean internal rotation (IR) was at L3. The mean Constant score was 58 ± 23 and subjective shoulder evaluation score 73 ± 12%. ranges of motion were better in the lateral than standard position group (AAE 133 ± 17 vs. 122 ± 23, P = .03; ER1 47 ± 13 vs. 30 ± 16, P < .001; IR T12 vs. L5, P = .02). The nail was less often protruding in the lateral than standard position group (1/20 [5%] vs. 20/52 [38.5%], P = .002). The nail was better positioned from the anteroposterior view (nail centered: 16/20 [75%] vs. 26/52 [50%], P = .047) and lateral view (nail centered: 18/20 [90%] vs. 34/52 [65.4%], P = .02) in the lateral than standard position group. We found no association between nail position, type of approach and CSA.
CONCLUSIONS: In the short-term follow-up, osteosynthesis of humeral shaft fractures by using long IMN in the lateral position with the Neviaser approach is a reliable technique. The positioning of the nail, in particular its entry point, and the clinical results were better with the lateral position and Neviaser approach than with the standard position and conventional approach. Further studies with a larger number of patients, assessment of the learning curve, and analysis of the impact of this technique on comorbidities (unchanged cerebral perfusion) are needed to fully validate this technique.