髓内钉与锁定接骨板治疗肱骨近端两部分骨折的Meta分析  

Meta analysis of clinical outcome of intramedullary nails versus locking plates for two-part proximal humerus fracture

作　　者：王磊[1] 王凤凤[2] 马延辉[1] 张杰[1] 呼芳[1] 马改平[1] 刘梅梅[1] 马张稳[1] 

机构地区：[1]延安大学附属医院骨科四病区,陕西省延安市716000 [2]延安大学附属医院血液免疫科,陕西省延安市716000

出　　处：《中国组织工程研究》2017年第3期478-484,共7页Chinese Journal of Tissue Engineering Research

摘　　要：背景:切开复位钢板内固定及闭合复位髓内钉内固定技术是治疗肱骨近端两部分骨折的常用方法,但对于哪种内固定更好仍然有很大争议。目的:应用Meta方法分析髓内钉与锁定接骨板治疗肱骨近端2部分骨折的疗效。方法:通过计算机检索Pub Med、SCI、Embase、Cochrane图书馆及中国生物医学数据库、维普信息数据库、万方数据库、中国期刊全文数据库,有关髓内钉与锁定接骨板治疗肱骨近端两部分骨折的随机对照和半随机对照试验,应用Rev Man 5.2统计学软件对两种治疗方式的手术时间、术中出血量、骨折愈合时间、术后并发症(异位骨化、内固定疼痛、螺钉切出、肱骨头坏死)、术后肩关节Constant评分等进行Meta分析。结果与结论:共纳入临床对照试验6个,共259例患者,其中接受髓内钉治疗131例,锁定接骨板治疗128例。Meta分析显示:髓内钉与锁定接骨板治疗肱骨近端两部分骨折的骨折愈合时间、异位骨化并发症发生率、术后内固定部位疼痛发生率、肱骨头坏死发生率、术后总体并发症发生率及术后肩关节Constant评分比较差异无显著性意义,但髓内钉治疗肱骨近端两部分骨折的手术时间、术中出血量、术后螺钉切出率明显少于锁定接骨板治疗(P<0.05)。结果表明对比锁定接骨板,髓内钉治疗肱骨近端两部分骨折可降低术后螺钉切出率。BACKGROUND： Intramedullary nails and locking plates are widely used for two-part proximal humerus fracture. Which is better for two types of implants in patients remains controversial.OBJECTIVE： To determine the clinical outcome of intramedullary nails versus locking plates for two-part proximal humerus fracture according to Cochrane Meta analysis. METHODS： We searched Pub Med, SCI, Embase, the Cochranel Library and CBMdisc, VIP information, Wanfang Database, and CNKI for randomized controlled trials and quasi-randomized controlled trials on intramedullary nails and locking plates for two-part proximal humerus fracture. Rev Man 5.2 software was used to analyze operation time, intraoperative blood loss, fracture healing time, postoperative complications（heterotopic ossification, pain, screw penetration, necrosis of humeral head）, and Constant Score. RESULTS AND CONCLUSION： Six articles of clinical controlled trials were included with 259 patients. 131 patients received intramedullary nails, and 128 patients received locking plates. Meta-analysis displayed that no significant difference in fracture healing time, heterotopic ossification, pain, necrosis of humeral head and Constant Score was detected between intramedullary nails and locking plates for two-part proximal humerus fracture. Operation time, intraoperative blood loss, and screw penetration were significantly less in the fixation with intramedullary nails than that in locking plates（P〈0.05）. These findings suggested that compared with locking plates, intramedullary nails method for two-part proximal humerus fractures could reduce screw penetration.

关 键 词：骨科植入物 骨植入物 肱骨近端两部分骨折 骨折固定 髓内钉 锁定接骨板 临床对照试验 META分析 

分 类 号：R318[医药卫生—生物医学工程]