| Objective: To evaluate the clinical effect of using the minimally invasive technique and by Phlios plate and Multiloc nail to treat the Neer 2 and3-part proximal humerul fractures.Methods : 47 cases of patients with proximal humerus fracture were accepted to receive fixation with locking Phlios plates(group A)or Multiloc intramedullary nails(group B).Anteroposterior and lateral X-ray films were used after 3 weeks,6 weeks,12 weeks,6 months,12 months postoperatively and last follow-up in neutral position and external rotation of shoulder joint,to determine fracture healing.At the last visit,visual analogue scale(VAS)pain score,American Shoulder and Elbow Surgeons(ASES)score and Constant-Murley score were used to evaluate the recovery of shoulder function.Results: All 47 patients completed the operation successfully.There were 24 cases in the Phlios plate group(Group A),including 9 males(37.5%)and 15 females(62.5%).The average operation time was 122.29 +32.70 min(60~200 min);The average follow-up time was 16.38 months(12m~24m),and the intraoperative blood loss was 44.17 + 17.42ml(20~80ml).There were 23 cases of Multiloc intramedullary nailing(Group B),including 9males(39.1%)and 14 females(60.9%).The average operation time was 154.87+ 35.78 min(57~205min).Follow-up time: average: 14.30 + 3.23 months(12m-24m);Intraoperative blood loss was 49.13 + 15.35ml(30-80ml).Non-fracture delayed healing and nonunion,fracture healing time between 1.5~3 months,average(2.42 + 0.62m)in Group A,and average(2.42±0.62m)in Group B.In our study,there were 5 cases of feeled painful in the 47 patients,including 3 cases in Group A and 2 cases in group B.The VAS score was 0.40 ± 0.52(0-1)on average at the end of the follow-up in group A,whlie the average score of VAS score was 0.18 + 0.40(0-1)at the end of the follow-up in group B,and the difference was not statisticallysignificant(P = 0.292).The average functions of shoulder were 169.17 ° ±9.29°(150°~180°),and 166.09°±9.88°(150°~180°)for group A and group B respectively for forward flexion,and the difference was not statistically significant(P = 0.227);41.25°±9.00°(20°~50°)and40.65°±7.58°(20°~50°)for lateral external rotation for group A,and B respectively,and the difference was not statistically significant(P = 0.807);147.50°±22.51°(110°~180°)and 149.13°±15.64°(130°~180°)for outreach for group A,and B respectively,and the difference was not statistically significant(P = 0.775).The average ASES score of the group A was 94.64 ± 3.31points(90-98.3points),and in group B was 92.66 ±4.10points(88.3-98points).The Constant score of the group A was 95.10± 3.12points(91-99points),and the Constant score of the intramedullary nail group was 91.45 + 5.85points(79-98points).There was no statistically significant difference between the two groups(both P > 0.05,table 2).In the3-parts of the fracture,the intramedullary nailing was longer than the plate in the operation time,and the difference was statistically significant(P=0.002),indicating that the degree of surgical difficulty determines the duration of the operation.In the intramedullary nail group,the ASES had a higher fracture rate in the 2 part fracture than in the 3 parts of the fracture(P=0.014),indicating that the fracture of the intramedullary nail group was better than that of 3 partial fractures.In the amount of blood loss,2 parts of the plate and the intramedullary nail and the steel plate group,3 parts were more fractured than 2 parts,and the intramedullary nail was more than the plate.In the two parts of the fracture,the Angle of intramedullary nail abduction is higher than the plate,indicating that in the treatment 2-part proximal humerul fracutres,the Multiloc nail has its advantages.There was no nonunion of fracture,wound infection and delayed union,rotator cuff injury and axillary nerve injury. |
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