髓内钉与经皮钢板固定肱骨干骨折比较

Intramedullary nailing versus minimal invasive percutaneous plate osteosynthesis for humeral shaft fractures

摘要:

［目的］ 比较髓内钉 （intramedullary nailing, IMN） 与微创经皮钢板 （minimally invasive percutaneous plate osteosynthe- sis, MIPPO）固定成人肱骨干骨折的疗效。［方法］回顾性分析 2016 年 1 月 1 日—2021 年 1 月 1 日收治的成人肱骨干骨折 59 例患者的临床资料。依据术前医患沟通结果，26 例采用 IMN 固定，33 例采用 MIPPO 固定。比较两组围手术期、随访和影像资料。［结果］两组均顺利完成手术，术后均未出现桡神经及肌皮神经麻痹。两组手术时间、术中失血量、切口愈合等级和住院时间的差异均无统计学意义 （P>0.05）。但是，MIPPO 组切口显著长于 IMN 组 （P<0.05），IMN 组术中透视次数及术后引流量显著多于 MIPPO 组（P<0.05）。两组患者均获随访 12 个月以上，随访过程中，骨不连并行翻修手术 IMN 组 4 例，而 MIPPO 组 0 例，差异有统计学意义（P<0.05）。肩部撞击痛并翻修 IMN 组 5 例，MIPPO 组 0 例，差异有统计学意义（P<0.05）。随术后时间推移，两组肩上举 ROM 和 UCLA 肩评分均显著改善（P<0.05）。术后各时间点，MIPPO 组的肩上举 ROM 和 UCLA 肩评分均显著优于 IMN 组（P<0.05）；但两组间肘伸屈 ROM 和 MEPS 评分的差异无统计学意义（P>0.05）。影像方面，两组骨折复位质量的差异无统计学意义（P>0.05），但是，MIPPO 组骨折影像骨折愈合时间显著早于 IMN 组（P<0.05）。［结论］本研究中 MIP- PO 治疗成人肱骨干骨折的临床效果显著优于 IMN。

Abstract:

[Objective] To compare the clinical efficacy of intramedullary nailing (IMN) versus minimally invasive percutaneous plate osteosynthesis (MIPPO) for humeral shaft fractures in the adult. [Methods] A retrospective study was done on 59 adult patients who re- ceived surgical treatment for humeral shaft fractures in our hospitals from January 1, 2016 to January 1, 2021. According to preoperative doctor- patient communication, 26 patients underwent IMN, while the remaining 33 patients had MIPPO used. The documents regarding perioperative period, follow-up and radiographs were compared between the two groups. [Results] All the patients in both groups had opera- tion performed successfully without radial nerve or musculocutaneous nerve paralysis after operation. There were no significant differences in terms of operation time, intraoperative blood loss, incision healing grade and hospital stay between the two groups (P>0.05) , however, the incision length was significantlly longer, and the number of intraoperative fluoroscopy and posteoerative drainage volume were significantly lower in MIPPO group than those in IMN group (P<0.05) . All patients in the two groups were followed up for more than 12 months. During the follow-up, revision surgery for fracture nonunion happened in 4 cases of the IMN group, while 0 case of the MIPPO group, which was statistically significant (P=0.035) . In addition, revision operation was performed for subacromial impingement in 5 cases of the IMN group, while 0 case of the MIPPO group, and the difference was statistically significant (P=0.013) . Shoulder lifting ROM and UCLA shoulder score significantly improved in both groups over time (P<0.05) . The MIPPO group proved significantly superior to the IMN group in terms of shoulder lifting ROM and UCLA shoulder score at all corresponding time points postoperatively (P<0.05) , however, there was no signifi- cant difference in elbow ROM and MEPS scores between the two groups (P>0.05) . Radiographically, there was no significant difference in fracture reduction quality after operation between the two groups (P>0.05) . However, the MIPPO group got fracture healing on images sig- nificantly earlier than the IMN group (P<0.05) . [Conclusion] In this study MIPPO achieves considerably better clinical outcome than the IMN in the treatment of adult humeral shaft fractures.