The Application And Effect Of Acromioplasty In Anterograde Intramedullary Nailing For Humeral Shaft Fracture

Humeral shaft fracture is one of the common fractures.The main surgical methods for adult humeral shaft fracture are open reduction and plate internal fixation and closed reduction and intramedullary nail internal fixation.At present,the gold standard for surgical treatment of humeral shaft fractures is open reduction and plate internal fixation.With the continuous improvement of intramedullary nailing technology,and its relative plate internal fixation has the advantages of simple operation,less surgical trauma and fewer complications,making this treatment method more and more widely used.However,due to the anatomical structure of the acromion,it is difficult to insert nails in the operation,and iatrogenic factors sometimes lead to acromial impingement after operation.Objective:To compare the curative effect of intramedullary nail combined with acromioplasty and traditional intramedullary nail internal fixation in the treatment of humeral shaft fracture,and to explore the difference of its clinical curative effect,so as to better carry out the surgical treatment of humeral shaft fracture and obtain better clinical curative effect.Methods:The data of 55 cases of closed humeral shaft fracture treated by orthopaedics department of the First Central Hospital of Baoding from Jan 2015 to May 2018 were retrospectively reviewed.26 cases with humeral shaft fracture treated by acromioplasty combined with anterograde intramedullary nail(observation group),and 29 treated by anterograde intramedullary nail(control group).The operation time,intraoperative bleeding volume,fracture healing time,incidence of subacromial impingement syndrome,Constant-Murley shoulder score and shoulder abduction angle at 6 months after operation were compared between the two groups.Results:All patients were followed up for 6 to 12 months.The average operation time of the two groups was(98.38±10.44)min in the observation group and(105.00±11.46)min in the control group,(90.19±25.59)ml in the observation group and(92.24±25.02)ml in the control group,(12.25±0.88)weeks in the observation group and(12.15±0.79)weeks in the control group.The results showed that the operation time of the observation group was shorter than that of the control group,and the difference was statistically significant(P < 0.05).There was no significant difference in bleeding volume and fracture healing time between the two groups(P > 0.05).The incidence of acromial impingement was higher in the control group than in the observation group(P < 0.05).Six months after operation,the shoulder joint Constant-Murley score was(88.92±4.79)in the observation group and(85.10±6.52)in the control group,and the shoulder joint abduction angle was(161.54±11.20)°in the observation group and(150.86±22.40)°in the control group.Six months after operation,the Constant-Murley score and shoulder abduction angle of the observation group were better than those of the control group,and the difference was statistically significant(P < 0.05).Conclusion:Anterograde intramedullary nailing combined with acromioplasty for humeral shaft fractures is beneficial to the placement of intramedullary nails.It can shorten the operation time and effectively prevent the occurrence of acromial impingement syndrome after operation and promote the recovery of shoulder joint function.