手术与非手术治疗肱骨干骨折安全性的Meta分析  

Comparison of the safety of surgical treatment versus nonsurgical treatment for humeral shaft fractures:a meta-analysis

作　　者：漆国栋 文化[1] 漆伟[1] 江琼[2] 张雪 李姝君 QI Guodong;WEN Hua;QI Wei;JIANG Qiong;ZHANG Xue;LI Shujun(Chongqing Orthopaedic Hospital of Traditional Chinese medicine,Chongqing 400010,China;College of Traditional Chinese Medicine.CQMU,Chongqing 400016,China)

机构地区：[1]重庆市中医骨科医院,重庆400010 [2]重庆医科大学中医药学院,重庆400016

出　　处：《中医正骨》2021年第8期33-38,42,共7页The Journal of Traditional Chinese Orthopedics and Traumatology

基　　金：重庆市科卫联合中医药技术创新与应用发展项目(2021ZY023901);重庆市名老中医药专家传承工作室建设项目(渝中医〔2020〕20号17)。

摘　　要：目的:比较手术与非手术治疗肱骨干骨折的安全性。方法:应用计算机检索PubMed、EMbase、CochraneLibrary、中国知网、万方数据库和维普网2011年1月至2021年1月收录的对比手术和非手术治疗肱骨干骨折的临床研究文献。由2名研究者根据纳入、排除标准及统一的文献信息提取表独立检索、筛选文献并提取数据,采用ROBINS-I和Cochrane偏倚风险评估工具对纳入文献的质量进行评估,采用RevMan5.3软件进行Meta分析。结果:共检索出658篇文献,最终纳入9篇文献,共涉及1513例肱骨干骨折患者,其中889例接受手术治疗、624例接受非手术治疗。Meta分析结果显示,手术组骨折不愈合率、骨折畸形愈合率、皮肤不良反应率均低于非手术组[I^(2)=28%,P=0.230,OR=0.32,95%CI(0.19,0.54);I^(2)=0%,P=0.470,OR=0.06,95%CI(0.01,0.23);I^(2)=0%,P=0.950,OR=0.09,95%CI(0.02,0.49)],手术组骨折延迟愈合率、医源性神经损伤率、手术部位感染率均高于非手术组[I^(2)=44%,P=0.150,OR=1.64,95%CI(0.94,2.86);I^(2)=0%,P=0.940,OR=4.75,95%CI(1.55,14.57);I^(2)=0%,P=0.930,OR=3.63,95%CI(0.93,14.17)]。结论:现有的证据表明,相较于非手术治疗,手术治疗肱骨干骨折的骨折不愈合率、畸形愈合率和皮肤不良反应率均较低,而骨折延迟愈合率、医源性神经损伤率和手术部位感染率均较高。Objective:To compare the safety of surgical treatment versus nonsurgical treatment for humeral shaft fractures.Methods:All articles concerning surgical treatment(surgical group)versus nonsurgical treatment(non-surgical group)for humeral shaft fractures that published at home and abroad included from January 2011 to January 2021 were retrieved from PubMed,EMbase,Cochrane Library,China National Knowledge Internet,W anF ang Database and VIP Database through computer.The articles were retrieved and screened and the in-formation was extracted independently by two researchers according to the inelusion and exclusion criteria as well as unified literature infor-mation extraction table.The methodological quality of research in the articles was evaluated by using ROBINS-land Cochrane bias risk as-sessment tools and a Meta-analysis was conducted by using RevMan 5.3 software.Results:Six hundred and fifty-eight articles were searched out.After screening,9 articles(1513 patients)were included in the final analysis,889 patients in surgical group and 624 patients in nonsurgical group.The results of Meta-analysis revealed that the fracture nonunion rate,fracture malunion rate and skin adverse reaction rate were lower in surgical group compared to nonsurgical group(I^(2)=28%,P=0.230,OR=0.32,95%CI(0.19,0.54);I^(2)=0%,P=0.470,OR=0.06,95%CI(0.01,0.23);I^(2)=0%,P=0.950,OR=0.0995%CI(0.02,0.49));while the fracture delayed union rate,iatrogenic nerve injury rate and surgical site infection rate were higher in surgical group compared to nonsurgical group(I^(2)=44%,P=0.150,OR=1.64,95%CI(0.94,2.86);I^(2)=0%,P=0.940,OR=4.75,95%CI(1.55,14.57);I^(2)=0%,P=0.930,OR=3.63,95%CI(0.93,14.17)).Conclusion:Available evidences suggest that the fracture nonunion rate,fracture malunion rate and sk in adverse reaction rate are lower,whereas the fracture delayed union rate,iatrogenic nerve injury rate and surgical site infection rate are higher in patients un-dergoing surgical treatment compared to nonsurgical treatment for humeral shaft fractures.

关 键 词：肱骨骨折 手术中并发症 手术后并发症 外科手术 非手术治疗 META分析 系统评价 

分 类 号：R687.3[医药卫生—骨科学]