髓内钉内固定与锁定钢板内固定治疗老年肱骨近端骨折疗效和安全性的Meta分析  

Clinical efficacy and safety of internal fixation with intramedullary nail versus locking plate for treatment of proximal humeral fractures in the aged:a meta analysis

作　　者：滕浩 杨胜真 孙然 王岩 王福栋 孟凯[2] TENG Hao;YANG Shengzhen;SUN Ran;WANG Yan;WANG Fudong;MENG Kai(The First Clinical Medical College of Shandong University of Traditional Chinese Medicine,Jinan 250014,Shandong,China;The Affiliated Hospital of Shandong University of Taditional Chinese Medicine,Jinan 250014,Shandong,China)

机构地区：[1]山东中医药大学第一临床医学院,山东济南250014 [2]山东中医药大学附属医院,山东济南250014

出　　处：《中医正骨》2023年第5期25-31,共7页The Journal of Traditional Chinese Orthopedics and Traumatology

摘　　要：目的:比较髓内钉内固定与锁定钢板内固定治疗老年肱骨近端骨折的疗效和安全性。方法:应用计算机检索中国知网、维普网、万方数据库、PubMed、Embase、Web of Science和Cochrane Library中关于髓内钉内固定与锁定钢板内固定治疗老年肱骨近端骨折的对比研究文献,检索时限均为建库至2022年4月。试验组采用髓内钉内固定治疗,对照组采用锁定钢板内固定治疗。依据文献检索及筛选方案筛选出符合要求的文献后,由2名研究人员分别独立进行数据提取和质量评价。采用Revman5.4软件进行Meta分析。结果:共检索到409篇文献,最终纳入8篇文献,共涉及566例患者。Meta分析结果显示,试验组手术时间、骨折愈合时间短于对照组[MD=-21.28,95%CI(-31.97,-10.59),P=0.000;MD=-0.54,95%CI(-0.77,-0.31),P=0.000],术中出血量少于对照组[MD=-93.06,95%CI(-146.47,-39.66),P=0.001],术后切口疼痛视觉模拟量表评分低于对照组[MD=-0.28,95%CI(-0.54,-0.02),P=0.030],骨折愈合后肱骨颈干角大于对照组[MD=3.81,95%CI(2.11,5.50),P=0.000];2组肩关节前屈活动度、肩关节外旋活动度、ConstantMurley肩关节评分、美国肩肘关节外科医师协会评分及并发症发生率比较,组间差异均无统计学意义[MD=0.04,95%CI(-3.11,3.18),P=0.980;MD=0.40,95%CI(-3.02,3.81),P=0.820;MD=0.89,95%CI(-0.96,2.73),P=0.350;MD=0.93,95%CI(-0.89,2.75),P=0.320;OR=0.66,95%CI(0.42,1.05),P=0.080]。结论:髓内钉内固定治疗老年肱骨近端骨折在恢复肩关节功能和安全性方面与锁定钢板内固定相当,但前者在缩短手术时间、减少术中出血量、缓解术后切口疼痛、促进骨折愈合、纠正肱骨颈干角等方面更具优势。Objective:To compare the clinical efficacy and safety of internal fixation with intramedullary nail(IMN)versus locking plate(LP)in treatment of proximal humeral fractures in the aged.Methods:All the randomized controlled trial(RCT)and non-RCT articles about clinical efficacy and safety of internal fixation with IMN(experiment group)versus LP(control group)for treatment of proximal humeral fractures in the aged included from database establishing to April 2022 were retrieved from China National Knowledge Internet,Vip Database,Wanfang Database,PubMed,Embase,Web of Science and Cochrane Library through computer.The articles were screened and the information was extracted independently by two researchers according to the retrieval and screening scheme.The methodological quality of research in the articles was evaluated independently by the same two researchers,and if any disagreement was found between them,discussion was conducted or another researcher was invited for making a final decision,and then a Meta-analysis was conducted by using Revman5.4 software.Results:Four hundred and nine articles were searched out.After screening,8 articles(566 patients)were included in the final analysis.The results of Meta-analysis revealed that the operative time and fracture healing time were shorter,the intraoperative blood loss was less,the postoperative incision pain visual analogue scale(VAS)score was lower and the humeral neck-shaft angle after fracture healing was greater in experiment group compared to control group(MD=-21.28,95%CI(-31.97,-10.59),P=0.000;MD=-0.54,95%CI(-0.77,-0.31),P=0.000;MD=-93.06,95%CI(-146.47,-39.66),P=0.001;MD=-0.28,95%CI(-0.54,-0.02),P=0.030;MD=3.81,95%CI(2.11,5.50),P=0.000).There was no statistical difference in range of motion of shoulder anteflexion and extorsion,Constant-Murley shoulder score,American shoulder and elbow surgeons(ASES)score and complication incidence between the 2 groups(MD=0.04,95%CI(-3.11,3.18),P=0.980;MD=0.40,95%CI(-3.02,3.81),P=0.820;MD=0.89,95%CI(-0.96,2.73),P=0.350;MD=0.93,95%

关 键 词：肩骨折 肱骨骨折 骨折固定术 内 骨钉 骨板 老年人 专题Meta分析 

分 类 号：R687.3[医药卫生—骨科学]