钢板内固定与半肩关节置换治疗老年复杂肱骨近端骨折效果的meta分析  

Meta analysis of locking plate fixation versus hemiarthroplasty for the treatment of complex proximal humeral fractures in elderly patients

作　　者：熊晨 衡立松[1] 崔玉 王晨[1] 何昌军 黄伟 朱养均[1] 张堃[1] XIONG Chen;HENG Lisong;CUI Yu;WANG Chen;HE Changjun;HUANGWei;ZHU Yangjun;ZHANG Kun(Department of Orthopaedic and Trauma,Honghui Hospital,Xi'an Jiaotong University,Xi'an 710054,China)

机构地区：[1]西安交通大学医学院附属红会医院创伤骨科,西安710054

出　　处：《中华骨与关节外科杂志》2022年第1期49-54,共6页Chinese Journal of Bone and Joint Surgery

基　　金：陕西省重点研发计划项目(2017SF-197);西安市科技计划项目[20YXYJ004(8)]。

摘　　要：目的:探讨钢板内固定与半肩关节置换在年龄大于65岁的复杂肱骨近端骨折患者中的治疗效果。方法:计算机检索PubMed、Embase、The Cochrane library、Web of Science、CBM、中国知网、万方、维普等数据库中比较钢板内固定术与半肩关节置换术治疗肱骨近端骨折疗效的文献。由两名研究员独立进行文献筛选、数据提取和质量评价。采用Review Manager 5.3软件进行meta分析,比较两种治疗方案的手术时间、术中出血量、并发症发生率、Constant-Murley肩关节评分、VAS评分。结果:共7篇文献纳入本研究。患者378例,钢板内固定治疗206例,半肩关节置换治疗172例。半肩关节置换在手术时间(MD=11.78,95%CI:5.31~18.25,P=0.0004)、术中出血量(MD=29.03,95%CI:0.71~57.35,P=0.0004)和并发症发生率(MD=2.04,95%CI:1.19~3.48,P=0.009)方面优于钢板内固定,差异具有统计学意义。两种治疗方案的Constant-Murley评分(MD=-3.65,95%CI:-8.73~1.44,P=0.16)和VAS评分(MD=0.27,95%CI:-0.48~1.03,P=0.48)比较差异无统计学意义。结论:钢板内固定术与半肩关节置换术治疗肱骨近端骨折的临床结果相似。相比半肩关节置换,钢板内固定术术中出血量多,手术时间更长,并且有更多的并发症。Objective: To investigate the effect of complex proximal humerus fracture plate internal fixation versus hemiarthroplasty in elderly patients aged over 65 years old. Methods: The literature on the comparison of efficacy between plate fixation and hemiarthroplasty for proximal humerus fractures was searched by computer in Pubmed, Embase, The Cochrane Library, Web of Science, CBM,CnKI, Wanfang and VIP databases. Literature screening, data extraction and quality evaluation were conducted independently by two researchers. Review Manager 5.3 software was used for meta analysis to compare the operation time, intraoperative blood loss, incidence of complications, Constant-Murley score and VAS score of the two treatment schemes. Results: A total of 7 articles were included in the study. A total of 378 patients were treated, 206 of whom received plate internal fixation and 172 patients received hemiarthroplasty.The operative time(MD=11.78, 95%CI: 5.31-18.25, P=0.0004), intraoperative blood loss(MD=29.03, 95%CI: 0.71-57.35, P=0.0004)and complication rate(MD=2.04, 95%CI: 1.19-3.48, P=0.009) of the two surgical plans were statistically significant. The hemiarthroplasty was superior to plate internal fixation in terms of the operative time, intraoperative blood loss and incidence of complications. There was no significant difference in the Constant-Murley score(MD=-3.65, 95% CI:-8.73-1.44, P=0.16) or VAS score(MD=0.27, 95% CI:-0.48-1.03, P=0.48) between the two treatment regimens. Conclusions: Similar clinical results can be obtained from plate fixation and hemiarthroplasty for proximal humerus fractures, but plate fixation may result in more intraoperative blood loss, longer operation time, and more complications than hemiarthroplasty.

关 键 词：内固定 META分析 肱骨近端骨折 关节置换 

分 类 号：R683.41[医药卫生—骨科学]