| Objective Humeral shaft fracture is more common in clinical,accounted for about 3% of all fractures [1] [2] [3] [4] [23],the current clinical treatment of humeral shaft fracture fixation techniques commonly used for locking compression plate(locking compression,plate,LCP)and internal fixation with interlocking intramedullary nail(locked intramedullary nail,IMN)internal fixation,two patients achieved good results [6] [7] [8] [9] is still controversial,how to choose the treatment method,the comparative study of locking compression plate(locking compression,plate,LCP)and interlocking intramedullary nail(locked intramedullary,nail,IMN)curative effect difference these two kinds of treatment of humeral shaft fracture mode,to provide reference for clinical decision making.Method Retrospective analysis the clinical data of 35 patients with humeral shaft fractures treated with LCP or IMN internal fixation from January 2013 to January 2016 were retrospectively analyzed.According to the different internal fixation methods,the patients were divided into LCP group(20 cases)and IMN group(n = 15).The operation time,hospitalization time and intraoperative blood loss of two groups were evaluated.Six months after operation,fracture healing and complications related to surgery(including radial nerve injury,nonunion,shoulder injury).The shoulder joint and elbow joint function were evaluated by ASES shoulder rating criteria and Mayo elbow joint assessment criteria 1 years after operation.Results the data were analyzed by SPSS15.0 statistical software.The measurement data to mean + standard deviation,comparison between groups using independent sample t test;count data between groups were compared using chi square test 2;ranked data between groups were compared using the Wilcoxon rank sum test;P<0.05 had statistically significant difference.Result LCP group of intraoperative blood loss more than IMN group,the difference was statistically significant(P= 0);the operation time in LCP group than IMN group,the difference was statistically significant(P<0.05),two groups of hospitalized time,there was no statistically significant difference(P<0.05).The two groups were followed up for an average of 12 months.LCP group of 3 cases(15%)found that the symptoms of radial nerve injury with swelling,nerve nutrition symptomatic disposal,discharge symptoms disappeared;IMN group found no symptoms of radial nerve injury;there was significant difference between two groups(P=0.047).6 months after operation,X-ray examination showed that there were no bone nonunion in LCP group(n = 5%)and IMN group(n = 0%)(),and the difference was not statistically significant(P> 0.05).In group IMN,2 cases(13.3%)had shoulder injury,relieved by medication and physical therapy,no shoulder injury occurred in LCP group,and there was significant difference between the two groups(P<0.05).1 years after the operation,compare two groups of shoulder and elbow joint function,there was no significant difference of elbow function(P> 0.05),the excellent rate of shoulder joint function in LCP group than in the IMN group,the difference was statistically significant;the excellent rate of LCP group and IMN group of shoulder joint function were 95%(19/20)and 73.3%(11/15),excellent rate of elbow function was 90%(18/20)and 93%(14/15).Conclusion At present,the treatment of humeral shaft fracture of these two methods have their own advantages and disadvantages.Locking compression plate for the treatment of humeral shaft fracture is easy to damage the radial nerve,and the amount of intraoperative bleeding.Interlocking intramedullary nail is easy to cause rotator cuff injury.Humeral shaft fracture internal fixation on the requirement of anti rotation ability is higher,the application of LCP should pay attention to avoid radial nerve injury during the operation,in the application of IMN to protect the rotator cuff,application of sharp separation,cold separation,immediate need to be buried in cortical bone.If the reduction is not ideal should be wary of soft tissue filling,the need for open reduction. |
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