肩峰下前外侧入路与肌间沟入路治疗肱骨近端骨折的Meta分析  

Anterolateral acromial approach versus interscalene approach in the treatment of proximal humeral fracture:a Meta-analysis

作　　者：王琳[1] 陈丹莹 崔岩[1] 张治宇[1] 

机构地区：[1]中国医科大学附属第四医院骨科,沈阳110032 [2]中国医科大学附属盛京医院康复科,沈阳110134

出　　处：《中国骨与关节外科》2017年第3期220-223,235,共5页Chinese Journal of Bone and Joint Surgery

摘　　要：背景:肱骨近端骨折在骨质疏松的老年患者中发生率较高,为了减少致残率,提高生活质量,绝大多数骨折均需要手术治疗。由于其特殊的解剖学特点,传统的肌间沟入路有较多缺陷,而近些年兴起的肩峰下前外侧入路治疗肱骨近端骨折,能够很好地避免传统手术入路存在的诸多问题,受到很多临床医师的认可。目的:评估肩峰下前外侧入路治疗肱骨近端骨折的有效性和安全性。方法:检索2017年3月前Pubmed、Embase、Medline、中国生物医学文献数据库(CBM)、中国知网(CNKI)及Cochrane临床试验数据库等数据库中,有关肩峰下前外侧入路与肌间沟入路治疗肱骨近端骨折比较的随机对照试验(RCTs),采用RevMan5.3进行Meta分析。结果:共纳入8篇文献,551例患者。Meta分析结果显示,肩峰下前外侧组手术切口长度(WMD=-6.98,95%CI:-7.73,-6.22,P<0.01)、手术时间(SMD=-23.76,95%CI:-29.36,-18.16,P<0.01)及术中出血量(SMD=-3.12,95%CI:-3.93,-2.32,P<0.01)优于肌间沟组;而两组间术后Constant肩关节功能评分(WMD=3.32,95%CI:-5.41,12.04,P=0.46)、术后1年Neer肩关节功能优良率(OR=2.44,95%CI:1.26,4.74,P=0.008)、骨折愈合时间(SMD=-0.53,95%CI:-0.98,-0.08,P=0.02)及并发症发生率(OR=0.18,95%CI:0.04,0.69,P=0.01)比较,均无统计学差异。结论:采用肩峰下前外侧入路治疗肱骨近端骨折,能够显著降低软组织创伤,临床效果显著,推荐广泛应用。Background： The proximal humeral fracture has a high incidence in osteoporotic elderly patients. Most of the fractures require surgical treatment in order to reduce the morbidity and improve the quality of life. The traditional interscalene approach has more defects due to its anatomical characteristics. In recent years, many doctors prefer to the anterolateral acromial approach to avoid many defects of traditional surgical approach. Objective： To assess the effectiveness and safety of anterolateral acromial approach in proximal humeral fracture. Methods： Databases including Pub Med, Embase, Medline,CBM, CNKI and Cochrane Central Register of Controlled Trial databases, were searched for relevant randomized controlled trials（RCTs） of anterolateral acromial approach versus interscalene approach in treatment of proximal humeral fracture published before March 2017. A Meta-analysis was performed utilizing the RevMan5.3 software. Results： Totally 8RCTs met the inclusion criteria, and there were 551 patients in those studies. Meta-analysis results showed that there were significant differences in terms of incision length（WMD=-6.98, 95%CI：-7.73,-6.22, P〈0.01）, operation time（SMD=-23.76,95%CI：-29.36,-18.16, P〈0.01） and intraoperative blood loss（SMD=-3.12, 95%CI：-3.93,-2.32, P〈0.01） between experimental group and control group. But there were no significant differences in the postoperative shoulder joint Constant function score（WMD=3.32, 95%CI：-5.41, 12.04, P=0.46）, excellent rate of Neer shoulder joint function in one year after surgery（OR=2.44, 95%CI： 1.26, 4.74, P=0.008）, fracture healing time（SMD=-0.53, 95%CI：-0.98,-0.08, P=0.02） or complication incidence（OR=0.18, 95%CI： 0.04, 0.69, P=0.01）. Conclusions： Treatment of proximal humeral fracture through anterolateral acromial approach can reduce damage of soft tissue and obtain significant clinical effect. It is recommended widely to be used.

关 键 词：肩峰下前外侧 肌间沟 肱骨近端骨折 手术入路 

分 类 号：R687.3[医药卫生—骨科学]