Lazaro Mesa, Christian M Schmidt, Reed Andrews, Mitchel John, Khaled Abdelghany, Maykel Dolorit, Mir Ibrahim Sajid, David Watson, Hassan R Mir
{"title":"利用微创旋转间隔技术（MIR-IT）进行肱骨髓内钉治疗改善肩关节损伤。","authors":"Lazaro Mesa, Christian M Schmidt, Reed Andrews, Mitchel John, Khaled Abdelghany, Maykel Dolorit, Mir Ibrahim Sajid, David Watson, Hassan R Mir","doi":"10.1097/BOT.0000000000002993","DOIUrl":null,"url":null,"abstract":"<p><strong>Objectives: </strong>To assess whether patients treated with a Minimally Invasive Rotator-Interval Technique (MIR-IT) versus the traditional technique of splitting the rotator cuff (RTCS) for intramedullary nailing of humeral shaft fractures resulted in comparable post-operative clinical and patient-reported outcomes (PROM).</p><p><strong>Methods: </strong>Design: Retrospective Cohort Study.</p><p><strong>Setting: </strong>Level 1 Trauma Center.</p><p><strong>Patient selection criteria: </strong>Patients >18yo with humeral shaft fractures (AO/OTA 12A-C) treated with IMN between 2015 and 2022.</p><p><strong>Outcome measures and comparisons: </strong>The primary outcome was differences in PROMs (ASES, Quick DASH, and Oxford Shoulder Score) between the MIR-IT and RTCS techniques. Secondary outcome measures included differences in rates of nonunion, superficial and deep surgical infections, wound dehiscence and iatrogenic nerve palsy between the two techniques.</p><p><strong>Results: </strong>Seventy-one patients underwent humeral IMN (MIR-IT - 39; RTCS - 32). Fifty-five patients (MIR-IT- 30; RTCS-25) had radiographic and clinical follow up to union. Mean follow up was 7.5 months (range: 3.1-16.8 months). Patients did not vary significantly with regards to age (MIR-IT: 54.4 ± 22.4; RTCS: 55.1 ± 18.5 years, p=0.896), and gender (Males- MIR-IT: 46.7%, RTCS: 44%, p=0.843). There were no significant differences in nonunion (7.4% vs 4.0% p=1.0), superficial infection (3.6% vs 4% p=1.0) or iatrogenic nerve palsy (3.6% vs 4.0% p=1.0) between the MIR-IT and RTCS groups. There were no deep infections or wound dehiscences in either group. Forty-two patients had PROMs (MIR-IT -21; RTCS -21). Average time to PROMs collection was 35.7 months (MIR-IT: 34.2 months, RTCS: 37.1 months, p=0.682). There were significantly better ASES scores (82.7 vs 71.6 p=.015), Quick DASH scores (9.7 vs 21.0 p=.011) and Oxford Shoulder Scores (39.3 vs 33.9 p=.042) amongst patients treated with the MIR-IT.</p><p><strong>Conclusions: </strong>Humeral IMN utilizing the MIR-IT resulted in better shoulder PROMs compared to the RTCS technique, with similarly low surgical complication rates.</p><p><strong>Level of evidence: </strong>Therapeutic Level II.</p>","PeriodicalId":16644,"journal":{"name":"Journal of Orthopaedic Trauma","volume":" ","pages":""},"PeriodicalIF":1.6000,"publicationDate":"2025-04-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":"{\"title\":\"Humeral Intramedullary Nailing Utilizing the Minimally Invasive Rotator-Interval Technique (MIR-IT) Improves Shoulder PROMs.\",\"authors\":\"Lazaro Mesa, Christian M Schmidt, Reed Andrews, Mitchel John, Khaled Abdelghany, Maykel Dolorit, Mir Ibrahim Sajid, David Watson, Hassan R Mir\",\"doi\":\"10.1097/BOT.0000000000002993\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<p><strong>Objectives: </strong>To assess whether patients treated with a Minimally Invasive Rotator-Interval Technique (MIR-IT) versus the traditional technique of splitting the rotator cuff (RTCS) for intramedullary nailing of humeral shaft fractures resulted in comparable post-operative clinical and patient-reported outcomes (PROM).</p><p><strong>Methods: </strong>Design: Retrospective Cohort Study.</p><p><strong>Setting: </strong>Level 1 Trauma Center.</p><p><strong>Patient selection criteria: </strong>Patients >18yo with humeral shaft fractures (AO/OTA 12A-C) treated with IMN between 2015 and 2022.</p><p><strong>Outcome measures and comparisons: </strong>The primary outcome was differences in PROMs (ASES, Quick DASH, and Oxford Shoulder Score) between the MIR-IT and RTCS techniques. Secondary outcome measures included differences in rates of nonunion, superficial and deep surgical infections, wound dehiscence and iatrogenic nerve palsy between the two techniques.</p><p><strong>Results: </strong>Seventy-one patients underwent humeral IMN (MIR-IT - 39; RTCS - 32). Fifty-five patients (MIR-IT- 30; RTCS-25) had radiographic and clinical follow up to union. Mean follow up was 7.5 months (range: 3.1-16.8 months). Patients did not vary significantly with regards to age (MIR-IT: 54.4 ± 22.4; RTCS: 55.1 ± 18.5 years, p=0.896), and gender (Males- MIR-IT: 46.7%, RTCS: 44%, p=0.843). There were no significant differences in nonunion (7.4% vs 4.0% p=1.0), superficial infection (3.6% vs 4% p=1.0) or iatrogenic nerve palsy (3.6% vs 4.0% p=1.0) between the MIR-IT and RTCS groups. There were no deep infections or wound dehiscences in either group. Forty-two patients had PROMs (MIR-IT -21; RTCS -21). Average time to PROMs collection was 35.7 months (MIR-IT: 34.2 months, RTCS: 37.1 months, p=0.682). 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引用次数: 0
摘要
目的：评估微创旋间技术（MIR-IT）与传统旋袖分离技术（RTCS）治疗肱骨干骨折的患者是否能产生可比较的术后临床和患者报告的结果（PROM）。方法设计：回顾性队列研究。地点：一级创伤中心。患者选择标准：2015 - 2022年间接受IMN治疗的> - 18yo肱骨干骨折（AO/OTA 12A-C）患者。结果测量和比较：主要结果是MIR-IT和RTCS技术之间PROMs （ASES， Quick DASH和Oxford肩部评分）的差异。次要结局指标包括两种技术间不愈合、浅表和深部手术感染、伤口裂开和医源性神经麻痹发生率的差异。结果：71例患者行肱骨IMN (MIR-IT - 39；RTCS - 32)。55例患者(MIR-IT- 30；RTCS-25)行影像学及临床随访。平均随访7.5个月（范围3.1 ~ 16.8个月）。患者在年龄方面无显著差异(MIR-IT: 54.4±22.4；RTCS: 55.1±18.5岁，p=0.896)，性别（男性- MIR-IT: 46.7%, RTCS: 44%, p=0.843）。MIR-IT组和RTCS组在骨不连（7.4% vs 4.0% p=1.0）、浅表感染（3.6% vs 4% p=1.0）或医源性神经麻痹（3.6% vs 4.0% p=1.0）方面无显著差异。两组均无深部感染和创面裂开。42例患者出现PROMs (MIR-IT -21；rtc -21)。平均收集PROMs时间为35.7个月（MIR-IT: 34.2个月，RTCS: 37.1个月，p=0.682）。在接受MIR-IT治疗的患者中，ASES评分（82.7 vs 71.6 p= 0.015）、Quick DASH评分（9.7 vs 21.0 p= 0.011）和Oxford肩部评分（39.3 vs 33.9 p= 0.042）均显著提高。结论：与RTCS技术相比，使用MIR-IT的肱骨内固定术产生了更好的肩部PROMs，手术并发症发生率也同样低。证据等级：治疗性II级。
Objectives: To assess whether patients treated with a Minimally Invasive Rotator-Interval Technique (MIR-IT) versus the traditional technique of splitting the rotator cuff (RTCS) for intramedullary nailing of humeral shaft fractures resulted in comparable post-operative clinical and patient-reported outcomes (PROM).
Methods: Design: Retrospective Cohort Study.
Setting: Level 1 Trauma Center.
Patient selection criteria: Patients >18yo with humeral shaft fractures (AO/OTA 12A-C) treated with IMN between 2015 and 2022.
Outcome measures and comparisons: The primary outcome was differences in PROMs (ASES, Quick DASH, and Oxford Shoulder Score) between the MIR-IT and RTCS techniques. Secondary outcome measures included differences in rates of nonunion, superficial and deep surgical infections, wound dehiscence and iatrogenic nerve palsy between the two techniques.
Results: Seventy-one patients underwent humeral IMN (MIR-IT - 39; RTCS - 32). Fifty-five patients (MIR-IT- 30; RTCS-25) had radiographic and clinical follow up to union. Mean follow up was 7.5 months (range: 3.1-16.8 months). Patients did not vary significantly with regards to age (MIR-IT: 54.4 ± 22.4; RTCS: 55.1 ± 18.5 years, p=0.896), and gender (Males- MIR-IT: 46.7%, RTCS: 44%, p=0.843). There were no significant differences in nonunion (7.4% vs 4.0% p=1.0), superficial infection (3.6% vs 4% p=1.0) or iatrogenic nerve palsy (3.6% vs 4.0% p=1.0) between the MIR-IT and RTCS groups. There were no deep infections or wound dehiscences in either group. Forty-two patients had PROMs (MIR-IT -21; RTCS -21). Average time to PROMs collection was 35.7 months (MIR-IT: 34.2 months, RTCS: 37.1 months, p=0.682). There were significantly better ASES scores (82.7 vs 71.6 p=.015), Quick DASH scores (9.7 vs 21.0 p=.011) and Oxford Shoulder Scores (39.3 vs 33.9 p=.042) amongst patients treated with the MIR-IT.
Conclusions: Humeral IMN utilizing the MIR-IT resulted in better shoulder PROMs compared to the RTCS technique, with similarly low surgical complication rates.
期刊介绍：
Journal of Orthopaedic Trauma is devoted exclusively to the diagnosis and management of hard and soft tissue trauma, including injuries to bone, muscle, ligament, and tendons, as well as spinal cord injuries. Under the guidance of a distinguished international board of editors, the journal provides the most current information on diagnostic techniques, new and improved surgical instruments and procedures, surgical implants and prosthetic devices, bioplastics and biometals; and physical therapy and rehabilitation.
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