MIPO技术结合锁定加压钢板、顺行交锁髓内钉及锁定加压钢板治疗肱骨干中段骨折疗效的对比研究

摘要 目的：探讨微创经皮钢板内固定（MIPO）技术结合锁定加压钢板、顺行交锁髓内钉、锁定加压钢板治疗肱骨干中段骨折的疗效。方法：选择2016年2月至2019年2月我院收治的126例肱骨干中段骨折患者,采用随机数字表法将其分为三组,MIPO组（42例）采用MIPO技术结合锁定加压钢板固定治疗,髓内钉组（42例）采用顺行交锁髓内钉固定治疗,钢板组（42例）采用锁定加压钢板固定治疗。所有患者术后随访12个月,比较三组手术时间、术中出血量、术后住院时间、骨折愈合时间、术前和术后第12个月美国加州大学肩关节评分系统（UCLA）评分、Mayo肘关节功能评分（MEPS）、欧洲五维健康量表(EQ-5D)评分以及并发症发生率。结果：MIPO组和髓内钉组的术中出血量与术后住院时间均少于钢板组（P＜0.05）,MIPO组和髓内钉组之间无统计学差异（P＞0.05）。MIPO组、钢板组骨折愈合时间短于髓内钉组（P＜0.05）,MIPO组、钢板组之间无统计学差异（P＞0.05）。MIPO组、钢板组术后第12个月UCLA评分均高于髓内钉组（P＜0.05）,MIPO组、钢板组之间无统计学差异,第12个月MEPS无差异（P＞0.05）。术后第12个月MIPO组、钢板组EQ-5D评分高于髓内钉组（P＜0.05）,MIPO组、钢板组之间无统计学差异（P＞0.05）。三组桡神经损伤、肩峰损伤发生率相比较,差异有统计学意义（P＜0.05）,桡神经损伤以钢板组发生率最高,肩峰损伤以髓内钉组发生率最高。结论：MIPO技术结合锁定加压钢板具有微创、术后恢复快、对肩关节功能及生活质量的影响较小、术后并发症较少的优势,是肱骨干中段骨折较为理想的治疗方式。

A Comparative Study of MIPO Combined with Locking Compression Plate, Antegrade Interlocking Intramedullary Nail and Locking Compression Plate in the Treatment of Middle Humeral Shaft Fracture

ABSTRACT Objective: To investigate the effect of minimally invasive percutaneous plate osteosynthesis(MIPO) combined with locking compression plate, antegrade interlocking intramedullary nail and locking compression plate in the treatment of middle humeral shaft fracture. Methods: 126 patients with middle humeral shaft fracture in our hospital were selected from February 2016 to February 2019, which were randomly divided into three groups, the patients in MIPO group(42 cases) were treated with MIPO technology combined with locking compression plate fixation, the patients in intramedullary nail group(42 cases) were treated with anterograde interlocking intramedullary nail fixation, and the patients in steel plate group(42 cases) were treated with locking compression plate fixation. All patients were followed up for 12 months, the operation time, intraoperative hemorrhage, postoperative hospital stay, fracture healing time, and the university of California at Los Angeles shoulder rating scale(UCLA) score, Mayo elbow performance score(MEPS), EuroQol five dimensions questionnaire(EQ-5D) score before operation and 12 months after operation and complication rate were compared among the three groups. Results: In MIPO group and intramedullary nail group, the amount of intraoperative bleeding and postoperative hospital stay were less than those in steel plate group (P<0.05), while there was no significant difference between MIPO group and intramedullary nail group(P>0.05). The fracture healing time of MIPO group and steel plate group was shorter than that of intramedullary nail group (P<0.05), while there was no significant difference between MIPO group and steel plate group(P>0.05). The UCLA scores of MIPO group and steel plate group were higher than those of intramedullary nail group(P<0.05), while there was no statistical difference between MIPO group and steel plate group, and there was no difference in MEPS at 12 months after operation(P>0.05). The scores of EQ-5D in MIPO group and steel plate group were higher than those in intramedullary nail group(P<0.05), whle there was no significant difference between MIPO group and steel plate group (P>0.05). There was significant difference in the incidence of radial nerve injury and acromion injury among the three groups (P<0.05). The incidence of radial nerve injury was the highest in the steel plate group and acromion injury was the highest in the intramedullary nail group. Conclusion: MIPO combined with locking compression plate has the advantages of minimally invasive, rapid postoperative recovery, less impact on shoulder function and quality of life, and less postoperative complications, which is an ideal treatment for middle humeral shaft fracture.