Comparison Of MIPO And Intramedullary Nail In The Treatment Of Comminuted Fractures Of The Humerus

Objective: To evaluate the clinical effect of MIPO technique combined with internal fixation with LCP plate and internal fixation with closed reduction and intramedullary nailing for the treatment of comminuted fracture of the humeral shaft.Methods:Retrospective analysis of 46 cases of humeral shaft comminuted fracture in the First Affiliated Hospital of Wangnan Medical College in 2014.4-2017.4.The average age is 20~67 years,with the average of them is 38.19 ± 16.74 years old.There were 31 case of males;15 case of females,and were divided into group MIPO(n=27)and group IMN(n=19)according to the operation method.The operative time,intraoperative blood loss,postoperative fracture healing time,iatrogenic radial nerve injury,infection,shoulder elbow activity range,shoulder and elbow pain were recorded and compared between the two groups.SPSS 22.0 is used to deal with statistical data.Results:All the 46 patients who met the inclusion criteria were followed up for 16 months or more.There was no significant difference in age,sex and type of fracture between MIPO group and IMN group.In terms of operation time and intraoperative bleeding,the average operation time of the patients in group MIPO was 104.6 minutes,and the average operation time of group IMN was 96.4 minutes.The average bleeding amount of the patients in group MIPO was 96.6 ml,and the mean mean intraoperative bleeding amount of IMN group was 107.63m1,the difference was not statistically significant.The average length of hospital stay in MIPO group was 13.8 days and the average healing time was 14.4 weeks.The average hospitalization time of group IMN was 14.2 days,and the average healing time was 14.9 weeks.There was no statistical difference.In group MIPO,there were 3 cases of nonunion and 2 cases of radial nerve palsy.For patients with nonunion,two operations were performed with plate and screw internal fixation.Autologous bone graft was performed during the operation,and 6 months after the follow-up.The shoulder joint Constant score was 90.6 points and the elbow joint Mayo score averaged 91.1 points.After group IMN,there were 4 cases of fracture nonunion and 1 cases of radial nerve paralysis.In this group,two times of internal fixation with plate and screw were performed for the two operation of fracture nonunion,autogenous bone graft was carried out in the operation,and the follow-up was 6 months after hospital follow-up.The shoulder joint Constant score was 86 points and the elbow joint Mayo score averaged 89.9 points.The symptoms of radial nerve palsy in two groups recovered spontaneously after February.Statistical analysis showed that the Constant score of shoulder joint had significant difference(p<0.05),and there was no significant difference between the two groups in the average time of hospitalization,the average healing time,the average operation time,the amount of intraoperative bleeding,the incidence of radial nerve injury and the Mayo score of the elbow joint.Conclusion: In this retrospective study,closed reduction and intramedullary nail fixation combined with MIPO technique combined with LCP plate internal fixation for the treatment of comminuted fracture of the humeral shaft had satisfactory fracture healing rate,and the postoperative intramedullary nail group was more likely to cause shoulder pain and reduce the range of movement.In contrast,the use of MIPO minimally invasive internal fixation can retain good shoulder and elbow function after surgery,so the use of MIPO technology has greater clinical advantages and advantages.