微创钢板与髓内钉内固定治疗肱骨干骨折的效果比较

Effect of minimally invasive percutaneous plate osteosynthesis versus minimally invasive intramedullary nailing osteosynthesis in the treatment of humeral shaft fracture

目的比较微创经皮钢板内固定(MIPO)和微创复位髓内钉内固定(MINO)治疗肱骨干骨折的临床效果。方法回顾性分析53例应用MIPO和MINO治疗的肱骨干骨折患者的临床资料,按照手术方式的不同将患者分成MIPO组25例、MINO组28例。比较2组手术时间、出血量、住院时间、骨折愈合时间、术后1年美国加州洛杉矶大学(UCLA)肩关节功能评分、肘关节功能Mayo评分。结果53例患者均顺利完成手术,术后均未出现手术切口感染、桡神经损伤、骨折不愈合、内固定断裂或松动等情况。2组患者手术时间、出血量、住院时间、骨折愈合时间和术后1年肘关节功能Mayo评分比较,差异无统计学意义(P>0.05)。MIPO组患者术后1年UCLA肩关节功能评分优于MINO组,差异有统计学意义(P<0.05)。MIPO组中有1例患者出现伤口脂肪液化,MINO组中有1例患者出现桡神经麻痹症状。结论MIPO和MINO在治疗肱骨干骨折方面均能达到满意效果,均值得临床推广,但MIPO对于肩关节功能的影响更小。

Objective To compare the clinical effects of minimally invasive percutaneous plate osteosynthesis(MIPO)and minimally invasive intramedullary nailing osteosynthesis(MINO)in the treatment of humeral shaft fractures.Methods The clinical data of 53 patients with humeral shaft fractures treated with MIPO and MINO were retrospectively analyzed.The patients were divided into MIPO group of 25 patients and MINO group of 28 patients according to differed surgical approaches.The operation time,blood loss,length of hospital stay,fracture healing time,University of California at Los Angeles(UCLA)shoulder function score at 1 year postoperatively,and Mayo elbow performance score at 1 year postoperatively were compared between the two groups.Results All 53 patients successfully completed the surgery,and no postoperative complications such as surgical site infection,radial nerve injury,fracture nonunion,implant breakage,or loosening occurred.There were no statistically significant differences between the two groups in terms of operation time,blood loss,length of hospital stay,fracture healing time,and Mayo elbow performance score at 1 year postoperatively(P>0.05).The UCLA shoulder function score at 1 year postoperatively was better in the MIPO group than in the MINO group(P<0.05).One patient in the MIPO group experienced wound fat liquefaction,and one patient in the MINO group experienced radial nerve palsy.Conclusion Both MIPO and MINO can achieve satisfactory results in the treatment of humeral shaft fractures,and both minimally invasive techniques are worthy of clinical promotion.However,MIPO has lesser impact on shoulder function.