锁定钢板与半肩关节置换治疗中老年复杂肱骨近端骨折的Meta分析  

Meta-analysis of locking plate versus hemiarthroplasty for complex proximal humeral fractures in middle-aged and elderly patients

作　　者：陈剑[1] 孙海飚[2] 韩晓强[2] 李光明[3] 张子楠 薛建刚 白浩 张锦涛 Chen Jian;Sun Haibiao;Han Xiaoqiang;LiGuangming;Zhang Zinan;XueJiangang;BaiHao;ZhangJinta(Shanxi Medical University,Taiyuan 030001,China;Department of Orthopaedics,First Hospital of Shanxi Medical University,Taiyuan 030001,China;Department of Orthopedics,Shanxi Armed Police Forces Hospital,Taiyuan 030006,China)

机构地区：[1]山西医科大学,太原030001 [2]山西医科大学第一医院骨科,太原030001 [3]武警山西总队医院骨科,太原030006

出　　处：《中华关节外科杂志（电子版）》2019年第3期320-328,共9页Chinese Journal of Joint Surgery(Electronic Edition)

摘　　要：目的 通过Meta分析探讨锁定钢板(LP)及半肩关节置换(HA)治疗肱骨近端骨折(PHFs)术后并发症及疗效的差异。方法 计算机检索Pubmed、Cochrane图书馆、EMBASE、ScienceDirect、中国知网、万方、维普等数据库。搜集有关LP/HA治疗PHFs的各种对照研究,纳入标准:随机或非随机对照试验;行LP和HA治疗;年龄≥ 45 岁;随访时间>3个月;可提取到可靠的数据。排除标准:病例数少于10例;其他治疗方式;病例报告,综述,动物实验以及系统评价;多种原因不能耐受手术;病理性骨折或者肱骨近端陈旧性骨折;既往有肩关节外伤及手术病史。研究共纳入27项研究 2 082 例患者,对纳入的文献选择总并发症、常见并发症(肩关节不稳、关节僵硬、肩峰下撞击症)、术后功能评分(Constant-Murley肩关节评分系统、美国肩肘外科医师协会评分)作为Meta分析的评价指标,采用STATA 14.0分析,对于合并 SMD 或者 OR , P <0.05差异有统计学意义。结果 结果表明两组总并发症[ OR =1.73,95% CI (1.35,2.21), P <0.01]、肩峰下撞击症[ OR =0.25,95% CI (0.11,0.55), P <0.01]以HA组较低;上肢肌力评分[ SMD =1.857,95% CI (0.803,2.912), P <0.01]、肩关节活动度评分[ SMD =2.542,95% CI (1.273,3.811), P <0.01]以LP组较优。两组CMS、ASES评分差异无统计学意义( P >0.05)。结论 HA术后并发症的发生率低于LP,两者均能获得相近的肩关节功能恢复。Objective To compare the compilications and outcomes of locking plate versus hemiarthroplasty in the treatment of proximal humeral fractures(PHFs) with meta-analysis.Methods Controlled clinical trials on LP/HA for the treatment of PHFs searched in Pubmed,the Cochrane Library,EMBASE,ScienceDirect,China National Knowledge Infrastructure,Wanfang,VIP Databas.Inclusion criteria:randomized or non-randomized controlled trials;LP and HA treatment;age ≥ 45 years old;follow-up time>three months;reliable data can be extracted.Exclusion criteria:the cases were less than 10;other treatment methods;case reports,reviews,animal experiments and systematic reviews;reasons cannot tolerate surgery;pathological fractures OR old fractures of the proximal humerus;history of shoulder injury and surgery.A total of 2 082 patients from 27 trials were included in this meta-analysis.STATA 14.0 was used to analyze the trials included in terms of total complications,common complications (shoulder instability,shoulder stiffness,subacromial impingement),postoperative functional scores,including Constant-Murley scores (CMS) and rating scales of American Shoulder and Elbow Surgeons (ASES) by meta-analysis.For combined SMD or OR,P<0.05 means significant difference.Results There were significant differences in total complications[ OR =1.73,95% CI (1.35,2.21),P<0.01],subacromial impingement [ OR =0.25,95% CI (0.11,0.55),P<0.01],which HA group were lower;while muscle strength of upper limbs score[ SMD =1.857,95% CI (0.803,2.912),P<0.01],range of motion [ SMD =2.542,95% CI (1.273,3.811),P<0.01],but not significant differences in CMS and ASES.Conclusion HA may have lower rate of overall incidence complications than LP,both of them could have similar shoulder function recovery.

关 键 词：肩骨折 内固定器 META分析 

分 类 号：R687.3[医药卫生—骨科学]