| Objective:To compare the advantages of minimally invasive percutaneous internal fixation of plate versus interlocking intramedullary nail for femoral shaft fractures in adults from the point of clinical and economic,providing a rationale for treating femoral shaft fractures.Method:According to design scheme of review,matching,control,adult patients with freshly closed femoral shaft fractures who were admitted to the No.2 Hospital of Baoding between January 2014 and March 2015 were selected.Patients who received minimally invasive percutaneous plate fixation and interlocking intramedullary nail internal fixation were assigned to the MIPPO group and the intramedullary nail group,respectively.Seventy patients were matched(1∶1)by the same gender,fracture AO classification,working nature and the similar age(±3 years),body mass index(±2Kg/m2),follow-up time(>12 months).Those patients enrolled were recorded in Excel regarding baseline data(age,body mass index,follow-up time,injury to operation time,sex,femoral shaft fracture AO type and side,the nature of the work,cause of injury,underlying disease,the nature of fracture),clinical index[the total length of the incision,operation time,intraoperative bleeding volume,postoperative hospitalization time,fracture healing time,serum high-sensitivity C reactive protein(preoperative,postoperative first and sevevth days,one day before leave hospital),morning temperature(preoperative and postoperative first second,third,sevevth day,one day before leave hospital),acesodyne unilization ratio(preoperative and postoperative first second,third,fourth,fifth,sixth,sevevth day,one day before leave hospital),clinical efficacy and complications],economic parameters(medical cost,inimum cost,cost effectiveness ratio and its sensitivity)etc by a double recording,specially-assigned person check and timely backup way.Differences between groups and within groups were compared with SPSS20.0,and there was statistical difference when P<0.05.Result:(1)The baseline data of the two groups were balanced pretty(P>0.05).Up to the following deadline,six patients were eliminated and 91.43% of the subjects completed the study.The following up time and median follow-up time were(12-25)months,14.6 months.(2)The clinical efficacy of two groups was comparable(P>0.05).In MIPPO group,23 cases were excellent,7 cases good,2 cases poor and the excellent and good rate was 93.75%.In intramedullary nail group,21 cases were excellent,8 cases good,3 cases poor and the excellent and good rate was 90.625%.(3)The operation time,intraoperative blood loss,fracture healing time of MIPPO group were less than those of intramedullary nail group(P<0.05).The total length of incision and the length of hospital stay of the two groups were similar(P>0.05).(4)There was no significant difference between the two groups’ serum high sensitivity C reactive protein(P>0.05).The first day after operation was significantly higher than preoperative in its groups and recovered to stable after the operation for seventh days.(5)There was no statistical difference between groups and within groups of morning temperature.(6)The acesodyne unilization ratio of MIPPO group postoperative first second,third day were 81.25%,78.125%,71.875%,which is lower than 93.75%,90.625%,84.375% in intramedullary nail group(P<0.05).The acesodyne unilization ratio of MIPPO group postoperative fourth,fifth,sixth,seventh day and one day before leave hospital were 62.50%,50.00%,15.625%,3.125%,3.125%,which were close to 71.875%,56.25%,21.875%,6.25%,3.125% in intramedullary nail group(P>0.05).(7)The incidence of complications was similar between the two groups(P>0.05).The incidence of MIPPO group was 9.375%,1 cases of superficial infection,1 cases of single screw loosening,1 cases of deep venous thrombosis of lower extremity.The incidence of intramedullary nail group was 12.50%,1 cases of superficial infection,1 cases of deep venous thrombosis of lower extremity,1 cases of delayed union,1 cases of mild traumatic arthritis.(8)The medical cost structure of two groups was similar.Direct medical costs of two groups,such as material fee,drug fee,inspection fee,treatment fee and other expenses etc,was close(P>0.05).The indirect medical costs of MIPPO group was lower than that of intramedullary nail group(P<0.05).The minimum cost and cost-effectiveness ratio of MIPPO group were(37.37±7.28)thousand yuan,422.89,which were lower than(44.51 ± 6.69)thousand yuan,533.35 in thousand yuan(P<0.05).The sensitivity analysis of loss work and material costs fluctuate from lower 10% to upper 10% showed that the minimum cost and cost-effectiveness ratio of MIPPO group were better than that of the intramedullary nail group.Conclusion:Both minimally invasive percutaneous internal fixations of plate and interlocking intramedullary nail can effectively treat adult patients with freshly closed femoral shaft fractures;minimally invasive percutaneous plate fixation is characterized by less bleeding,ight postoperative pain,fast union,low minimum cost and cost-effectiveness ratio. |
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