RESUMEN
OBJECTIVES: To compare the iatrogenic radial nerve injury (iRNI) rate of different implant (plate vs. intramedullary nail) and surgical approaches during humeral shaft fracture surgery. METHODS: The online PubMed database was used to search for articles describing iRNI after humeral fracture with a publication date from Jan 2000 to October 2023. The following types of articles were selected: (1) case series associating with adult humeral shaft fracture, preoperative radial nerve continuity, non-pathological fracture and non-periprosthetic fracture; (2) involving humeral shaft (OTA/AO 12) fractures. Articles where we were unable to judge surgical approach or fracture pattern (OTA/AO 12) were excluded. The data were analyzed by SPSS 27.0 and Chi-square test was performed to identify incidence of iRNI associated with different implant and surgical approaches. RESULTS: Fifty-four articles with 5063 cases were included, with 3510 cases of the plate, 830 cases of intramedullary nail and 723 cases of uncertain internal fixation. The incidences of iRNI with plate and intramedullary nail were 5.95% (209/3510) and 2.77% (23/830) (p < 0.05). And iRNI incidences of different surgical approaches were 3.7% (3/82) for deltopectoral approach, 5.74% (76/1323) for anterolateral approach, 13.54% (26/192) for lateral approach and 6.68% (50/749) for posterior approach. The iRNI rates were 0.00% (0/33) for anteromedial MIPO, 2.67% (10/374) for anterolateral MIPO and 5.40% (2/37) for posterior MIPO (p > 0.05). The iRNI rates were 2.87% (21/732) for anterograde intramedullary nail and 2.04% (2/98) for retrograde intramedullary nail (p > 0.05). In humeral bone nonunion surgery, the rate of iRNI was 15.00% (9/60) for anterolateral approach, 16.7% (2/12) for lateral approach and 18.2% (6/33) for posterior approach (p > 0.05). CONCLUSION: Intramedullary nailing is the preferred method of internal fixation for humeral shaft fractures that has the lowest rate of iRNI. Compared with anterolateral and posterior approaches, the lateral surgical approach had a higher incidence of iRNI. The rate of iRNI in MIPO was lower than that in open reduction and internal fixation. LEVEL OF EVIDENCE: Level IV.
Asunto(s)
Fijación Intramedular de Fracturas , Fracturas del Húmero , Enfermedad Iatrogénica , Nervio Radial , Humanos , Fracturas del Húmero/cirugía , Nervio Radial/lesiones , Nervio Radial/cirugía , Fijación Intramedular de Fracturas/efectos adversos , Fijación Intramedular de Fracturas/métodos , Placas Óseas/efectos adversos , Fijación Interna de Fracturas/métodos , Fijación Interna de Fracturas/efectos adversos , Clavos Ortopédicos/efectos adversos , IncidenciaRESUMEN
OBJECTIVE: To design chimeric DNA vaccine targeted to antigen-presenting cells (APCs) with enhanced efficacy to induce immunization. METHODS: The plasmid containing the gene encoding cytotoxic T-lymphocyte antigen 4 (CTLA4), a surface molecule on T cells, was directly fused to the gene fragment HEVE2 coding for hepatitis E virus antigen by molecular engineering technology. The plasmid containing HEVE2 gene fragment alone was also constructed to serve as control and transfection of COS-7 cells with the 2 resultant plasmids was performed respectively, followed by assay of the expressions of CTLA4- HEVE2 fusion protein and HEVE2 protein in COS-7 cells by way of Western blotting. BALB/c mice were injected intracutaneously with the DNA vaccine (100 microgram) for 3 times at 2-week intervals, and the titer of anti-HEVE2 total IgG and IgG subclasses were determined by enzyme-linked immunosorbent assay (ELISA). RESULTS: The mammalian expression plasmids of CTLA4-HEVE2 fusion protein or HEVE2 protein alone were cloned. The culture supernants of COS-7 cells transfected with the plasmids showed the production of CTLA4-HEVE2 and HEVE2 proteins, which were secreted in the form of dimers. Mice immunized with pCTLA2-HEVE2 produced high levels of specific anti-HEVE2 total IgG titers with IgG2a, IgG2b and IgG1 subclasses predominant in the serum, approximately 50- to 100-fold higher than those in mice immunized with pHEVE2, whose serum contained predominantly IgG1. CONCLUSION: CTLA4-HEVE2 chimeric vaccine stimulates strong immune responses in mice, making it possible for further exploration into chimeric DNA vaccines that target the antigen to APCs.