Comparison Of The Clinical Efficacy Between Two Surgical Methods For Comminuted Femoral Shaft Fracture In Adults

ObjectiveTo compare and analyze the clinical efficacy of closed reduction with interlocking intramedullary nail and minimally invasive percutaneous plate osteosynthesis in the treatment of comminuted femoral shaft fracture in adults,and provide some experience and reference for the clinical treatment of adult comminuted femoral shaft fracture.MethodA retrospective study was conducted to analyze the clinical data of 86 patients with comminuted femoral shaft fracture in adults from May 2017 to June 2019 in the Orthopaedic Department of The First Affiliated Hospital of Zhengzhou University.There were 62 males and 24 females,aged from 19 to 61 years,with an average age of(37.33±9.29)years.According to the surgical method,they were divided into group A(group with closed reduction with interlocking intramedullary nail,n=44 cases)and group B(group with minimally invasive percutaneous locking compression plate osteosynthesis,n=42 cases).Operative time,Intraoperative blood loss,Fluoroscopy times,Fracture healing time and complications of the two groups were recorded.The function of hip and knee was evaluated by the Harris and HSS score,and the statistical analysis was performed.ResultsThe two group patients completed the operation successfully,and all of them were followed up for 6?24 months(median 18 months).The general data of the two groups were compared and analyzed,and the difference was not statistically significant(P>0.05).The operative time:group A was(124.64±26.87)min,and group B was(113.95±22.21)min.The difference was statistically significant(P<0.05).The Intraoperative blood loss was(231.82±76.96)ml in group A and(223.57±64.31)ml in group B.The difference was not statistically significant(P>0.05).The fluoroscopy times:the intraoperative fluoroscopy times were(18.50±3.94)in group A and(13.261±2.93)in group B.The difference was statistically significant(P<0.05).The fracture healing time:the fracture healing time was(4.25±1.31)months in group A,and(4.97±1.96)months in group B.The difference was statistically significant(P<0.05).Complications:a total of 5 patients in group A had complications,with a complication rate of 11.36%.There were 6 postoperative complications in group B,with a complication rate of 14.29%.And the difference was not statistically significant(P>0.05).For all patients,the function of hip and knee was evaluated according to the Harris and HSS score at the last follow-up.Harris score:group A was excellent in 17 cases,good in 23 cases,fair in 3 cases,and poor in 1 case,and the excellent and good rate was 90.91%;13 cases were excellent,24 cases were good,4 cases were fair,and 1 case was poor in group B,and the excellent and good rate was 88.10%.The difference was not statistically significant(P>0.05).HSS score:group A was excellent in 22 cases,good in 19 cases,fair in 3 cases,and poor in 0 cases,and the excellent and good rate was 93.18%;17 cases were excellent,21 cases were good,2 cases were fair,and 2 cases were poor in group B,and the excellent and good rate was 90.48%.The difference was not statistically significant(P>0.05).ConclusionsFor comminuted femoral shaft fracture in adults,both of closed reduction with interlocking intramedullary nail and minimally invasive percutaneous locking compression plate osteosynthesis are effective treatment methods.Both can effectively reduce the damage of soft tissue and periosteum,and protect the blood supply at the fracture end.But comparatively speaking:(1)Closed reduction with interlocking intramedullary nail can effectively shorten the fracture healing time,but the operation is relatively complicated.(2)The operative time and the fluoroscopy times of minimally invasive percutaneous locking compression plate osteosynthesis are less than those of closed reduction with interlocking intramedullary nail.And its operation is also relatively simple.(3)However,in the aspects of intraoperative blood loss,complications and excellent and good rate of hip and knee function,the results of the two treatment methods are not significantly different.