A Comparative Study Of Minimally Invasive Anterior Approach And Traditional Anterior Approach In The Treatment Of Proximal Humeral Fractures

Objective:To explore the effect of minimally invasive plate osteosynthesis MIPO(minimally invasive plate osteosynthesis MIPO)through anterior approach of shoulder joint combined with the proximal humeral internal locking system(PHILOS)and traditional anterior approach of shoulder joint combined with the proximal humeral locking system in the treatment of proximal humeral fracture.Method:We collected 62 patients with proximal humerus fractures who met the inclusion criteria from January 2016 to June 2019.Thirty patients with a minimally invasive anterior shoulder approach combined with PHILOS internal fixation for proximal humeral fractures were divided into MIPO groups.Thirty-two patients with traditional anterior shoulder approach combined with PHILOS internal fixation for proximal humeral fractures were divided into ORIF groups.Through a retrospective study,the general data(age,gender,injury site,fracture type),surgical incision length,operation time,intraoperative blood loss,mean hospital stay,postoperative VAS score,fracture healing time,the postoperative complications and postoperative shoulder joint function Neer scores were compared the clinical efficacy of surgical treatment between the two groups.Result:There were 30 patients in the MIPO group and 32 patients in the ORIF group.All patients were followed up for 12-24 months,with an average follow-up time of16.6 months.There was no significant difference in the basic information(age,gender,injury site,fracture type)between the patients with minimally invasive anterior shoulder approach MIPO group and the traditional anterior shoulder approach ORIF group(P> 0.05).The surgical incision length,operation time,intraoperative blood loss,postoperative VAS score,fracture healing time,andshoulder function of the patients with minimally invasive anterior shoulder approach MIPO group were significantly better than those of the traditional anterior shoulder approach ORIF group,The results are statistically significant(P <0.05).There was no significant difference in the length of stay between the two groups(P > 0.05).Based on the evaluation of the Neer score of the shoulder function of the patients,the MIPO group with a minimally invasive shoulder anterior approach was excellent in 17 cases,good in 10 cases,fair in 3 cases,and excellent and good rate was 90%.In the traditional shoulder anterior ORIF group,16 cases were excellent,11 cases were good,and 5 cases were medium,with a good rate of 84.3%.There was no statistically significant difference in the postoperative good rate between the two groups(P>0.05).In the traditional anterior approach ORIF group,1 case of shoulder joint stiffness was found,while in the MIPO group,1 case of postoperative superficial incision infection was found.There were no complications,such as deep postoperative infection,delayed fracture healing,screw release,and internal fixation failure in both groups.There was no significant difference in postoperative complications between the two groups(P > 0.05).Conclusion:Minimally invasive frontal approach MIPO technology combined with the proximal humerus internal fixation and locking system for the treatment of proximal humeral fractures has the advantages of less trauma,fast postoperative recovery,and better shoulder function recovery.It is a safe,minimally invasive and effective treatment method,suitable for clinicians to choose and apply,and it is worthy of popularization and use by primary hospitals.