老年肱骨近端三、四部分骨折手术与保守治疗的Meta分析  

Surgical Treatment versus Conservative Treatment for Three-part or Four-part Proximal Humeral Fractures in Elderly Patient: A Meta-analysis of Randomized Controlled Trials

作　　者：陈彦影[1] 徐龙[1] 黄富国[1] 

机构地区：[1]四川大学华西医院骨科,成都610041

出　　处：《华西医学》2015年第11期2040-2045,共6页West China Medical Journal

摘　　要：目的评估老年性肱骨近端3、4部分骨折手术与保守治疗的疗效,以期为临床上治疗方式的选择提供参考。方法检索中国知网(1979年1月-2014年4月)、万方数据库(1982年1月-2014年4月)、Medline(1946年1月-2014年4月)、Pub Med(1966年1月-2014年4月)、Embase(1974年1月-2014年4月)、Cochrane Database of Systematic Reviews(2005年1月-2014年4月)等数据库中关于老年肱骨近端3、4部分骨折手术与非手术治疗疗效比较的随机对照研究(RCT),纳入符合标准的文献,提取相关数据输入Rev Man 5.2软件进行统计学分析。结果 5篇文献共计226例患者被纳入研究,Meta分析结果显示,手术组与非手术组Constant评分差异无统计学意义[WMD=0.48分,95%CI(-4.39,5.35)分,P=0.85],后期肱骨头缺血性坏死(ANV)发生率差异无统计学意义[RR=0.66,95%CI(0.37,1.16),P=0.15],骨折不愈合发生率差异无统计学意义[RR=0.56,95%CI(0.20,1.58),P=0.27],骨关节炎发生率差异无统计学意义[RR=0.35,95%CI(0.10,1.22),P=0.10];手术组再次手术治疗的发生率高于非手术组,差异有统计学意义[RR=3.52,95%CI(1.18,10.45),P=0.02]。结论老年肱骨近端3、4部分骨折在Constant评分,后期发生ANV、骨折不愈合及骨关节炎等方面手术组和非手术组结果无明显差异,但手术治疗后期再手术率高于非手术治疗。考虑手术会增加患者的创伤以及经济负担,故建议对此类患者应采用保守治疗方式为宜。Objective To assess the effect of surgical treatment or conservative treatment on the clinical outcomes for displaced 3-part or 4-part proximal humeral fractures in elderly patients. Methods We searched CNKI（between January 1979 and April 2014）, Wanfang Data（between January 1982 and April 2014）, Medline（between January 1946 and April 2014）, Pub Med（between January 1966 and April 2014）, Embase（between January 1974 and April 2014） and Cochrane Database of Systematic Reviews（between January 2005 and April 2014） for randomized controlled trials comparing surgical treatment and conservative treatment for displaced 3-part or 4-part proximal humeral fractures in elderly patients. The data were extracted and a Meta-analysis was made using Rev Man 5.2. Results Five randomized controlled trials with a total of 226 patients were accepted in this Meta-analysis. The differences of Constant scores [WMD=0.48, 95%CI（-4.39, 5.35）, P=0.85], incidences of avascular necrosisr of the humeral head [RR=0.66, 95%CI（0.37, 1.16）, P=0.15], incidences of nonunion [RR=0.56, 95%CI（0.20, 1.58）, P=0.27], incidences of osteoarthritis [RR=0.35, 95%CI（0.10, 1.22）, P=0.10] between the two groups were not statistically different. The difference of incidences of additional surgery after primary treatment was statistically significant [RR=3.52, 95%CI（1.18, 10.45）, P =0.02]. Conclusions The results does not support the surgical treatment to improve the shoulder function when comparedwith conservative treatment for treating elderly patients with displaced 3-part or 4-part proximal humeral fractures. But surgical treatment increases the incidence of additional surgery after primary treatment. Considering surgery can increase the trauma and economic burden of patients, so the conservative treatment is suggested.

关 键 词：肱骨近端骨折 保守治疗 手术治疗 老年 META分析 

分 类 号：R687.3[医药卫生—骨科学]