Comparison Of Clinical Efficacy Between Locking Compression Plate And Anterograde Interlocking Intramedullary Nail In The Treatment Of Middle Humeral Shaft Fracture

Objectives:The functional outcome,healing time and complication rate of adult middle humeral shaft fractures treated with locking compression plate(locking compression plate,LCP and anterograde interlocking interlocking intramedullary nail(intramedullary nail,IMN)were analyzed retrospectively.Methods : Recalling 36 patients with middle humeral shaft fractures who underwent surgical treatment from January 2015 to January 2018 in our hospital,who met the inclusion criteria and were divided into two groups: LCP group and AIIN group according to different surgical methods,Among them,20 cases were treated with LCP open reduction and internal fixation,16 cases were treated with AIIN closed reduction and internal fixation.The bleeding volume,operation time,hospital stay,related complications(including radial nerve paralysis,infection,delayed union of fracture,shoulder joint dysfunction)and fracture healing time were recorded and compared between the two groups.Regular use of out-patient and telephone services within 1 year after operation NEER score was used to evaluate the shoulder function and MEPI score was used to evaluate the elbow function.The results were analyzed by SPSS19.0statistical software.The measurement data were expressed as (?)±s and analyzed statistically by t-test,χ2test was used to compare the counting data between the two groups,rank sum test was compared between the two groups,P < 0.05,the difference between the two groups was statistically significant.Results:Compared with AIIN group,the operative time in LCP group(102.05±17.82)min was significantly longer than that in AIIN group(71.44 ±13.31)min,(P <0.05).The amount of hand bleeding in LCP group was(255.25 ±54.54)ml higher than that in AIIN group(140.31 ±33.89)ml,(P<0.05),but there was no significant difference in hospitalization time and fracture healing time between the two groups(P>0.05).All the patients in the two groups were followed up with an average follow-up of about 1year.LCP group The shoulder joint score of NEER(97.45 ±2.96)was significantly higher than that of AIIN(89.94 ±5.65)(P<0.05).The score of MEPI elbow joint in LCP group(90.1±3.92)was slightly lower than that in AIIN group(91.56 ±2.87),and there was no significant difference(P=0.221).Comparison of postoperative complications:one case(6.25%)had radial nerve paralysis in AIIN group,and there was no symptom of radial nerve paralysis in locking plate group.There was no significant difference between the two groups(P < 0.05).There was no significant difference between the two groups(P<0.05).The incision healed smoothly in 5%,AIIN group,and there was no significant difference between the two groups(P = 1.000).There were 1 case of delayed union in LCP group and 1 case in AIIN group after operation.The average healing time of LCP group was(13.00 ±1.69)weeks and that of AIIN group was(13.44 ±1.67)weeks,except 2 cases of delayed healing,and the average healing time of LCP group and AIIN group were(13.44 ±1.67)weeks,and the average healing time of AIIN group was(13.44 ±1.67)weeks.There was no statistical significance between the two groups(P=1.000).Postoperative follow-up showed that there were 2 patients(12.5%)with shoulder dysfunction in AIIN group(Neer score was lower than 70 points).No significant difference was found between LCP group and AIIN group(90.0%and81.25% respectively in P=0.190).LCP group and AIIN group(P<0.05),but no significant difference was found between the two groups(P = 0.190).The excellent and good rates of elbow joint function were 90.0% and 93.75%,respectively.There was no significant difference between the two groups(P > 0.05).Conclusions:Compared with LCP,AIIN has less surgical trauma in the treatment of humerus midshaft fractures,and has more advantages in reducing local blood supply destruction,promoting fracture healing,reducing infection rate and made the fixation more reliable.However,LCP fixation should be adopted for patients who have been complicated with neurovascular injury,or need to perform nerve and vascular exploration and anastomosis at the same time.