微创经皮接骨板与切开复位钢板内固定治疗肱骨干骨折疗效的Meta分析  

Minimally invasive plate osteosynthesis versus open reduction and internal fixation for humeral shaft fractures:a Meta-analysis

作　　者：陈韬予 韩鹏飞[1] 李鹏翠[1] 魏垒[1] 卫小春[1] Chen Taoyu;Han Pengfei;Li Pengcui;Wei Lei;Wei Xiaochun

机构地区：[1]山西医科大学第二医院骨科-骨与软组织损伤修复重点实验室,太原030001

出　　处：《中华创伤骨科杂志》2019年第5期416-421,共6页Chinese Journal of Orthopaedic Trauma

基　　金：国家自然科学基金(81601949);科技部国家国际科技合作专项项目(2015DFA33050).

摘　　要：目的通过Meta分析比较微创经皮接骨板(MIPO)与切开复位钢板内固定(ORIF)治疗肱骨干骨折临床疗效的差异。方法计算机检索PubMed数据库、Cochrane数据库、中国知网数据库、万方数据库,辅以手工检索、文献追溯相关文献,收集2010年1月至2018年6月国内外已发表关于MIPO与ORIF治疗肱骨干骨折对照研究中、英文文献,严格评价质量及提取相关数据,运用REVMAN5.3软件统计分析两组患者在美国加州大学肩关节功能评分系统(UCLA)评分、Mayo肘关节功能评分标准评分(MEPS)、骨折愈合时间、骨折不愈合率和并发症发生率等方面的差异。结果本研究共纳入9项研究,共452例肱骨干骨折患者,其中MIPO组216例,ORIF组236例。Meta分析结果显示:MIPO组患者在UCLA肩关节功能评分(WMD=0.36,P=0.03)较ORIF组更高,并发症发生率(OR=-0.15,P<0.05)及医源性桡神经损伤发生率(OR=0.24,P<0.05)较ORIF组低,骨折愈合时间(SMD=-0.36,P=0.02)较ORIF短。而MIPO组和ORIF组患者在MEPS评分(WMD=-0.48,P=0.43)、骨折不愈合率(OR=0.45,P=0.11)方面差异无统计学意义。结论对于肱骨干骨折,MIPO是一种很好的手术方式,在术后肩关节功能、骨折愈合时间、并发症发生率和医源性桡神经损伤率方面均优于ORIF。Objective To compare the efficacy and safety between minimally invasive plate osteosynthesis(MIPO)and open reduction and internal fixation(ORIF)in the treatment of humeral shaft fracture.Methods Case-control studies and randomized clinical trials comparing MIPO with ORIF in the treatment of humeral shaft fracture from January 2010 to June 2018 were retrieved from PubMed Library,Cochrane Library,Embase Library,China National Knowledge Internet and Wanfang Data.Methodological quality of the studies and trials was critically assessed.REVMAN5.3 was used for data analysis.The 2 groups of patients were compared in terms of University of California,Los Angeles shoulder rating scale(UCLA),Mayo Elbow Performance Score(MEPS),union time,nonunion rate and complications.Results A total of 452 patients from 9 articles were included.There were 216 cases in the MIPO group and 236 ones in the ORIF group.The Meta analyses showed that the MIPO group had a significantly higher UCLA score(WMD=0.36,P=0.03),significantly lower incidences of complications(OR=-0.15,P<0.05)and iatrogenic radial nerve palsy(OR=0.24,P<0.05),and significantly shorter union time(SMD=-0.36,P=0.02)than the ORIF group.There were no significant differences between the 2 groups in MEPS(WMD=-0.48,P=0.43)or nonunion rate(OR=0.45,P=0.11).Conclusion MIPO may be a better choice for humeral shaft fracture than ORIF in regards to postoperative shoulder functions,union time,and incidences of complications and iatrogenic radial nerve palsy.

关 键 词：手术治疗 微创性 骨折固定术 内 骨板 META分析 肱骨干骨折 

分 类 号：R687.3[医药卫生—骨科学]