关节镜下复位双排锚钉缝线桥固定治疗移位肱骨大结节骨折疗效的meta分析  

The effect of arthroscopic double-row anchored suture bridge for the treatment of displaced humerus greater tuberosity fractures:a meta-analysis

作　　者：向飞帆 谭小琦 魏代清 范玮 杨楷文 阳运康 XIANG Feifan;TAN Xiaoqi;WEI Daiqing;FAN Wei;YANG Kaiwen;YANG Yunkang(Department of Orthopaedics,The Affiliated Hospital of Southwest Medical University,Luzhou,Sichuan 646000,China;Sichuan Provincial Laboratory of Orthopaedic Engineering,Luzhou,Sichuan 646000,China;Department of Dermatology,Affiliated The Hospital of Southwest Medical University,Luzhou,Sichuan 646000,China)

机构地区：[1]西南医科大学附属医院骨科,四川泸州646000 [2]四川省骨科置入器械研发应用技术工程实验室,四川泸州646000 [3]西南医科大学附属医院皮肤科,四川泸州646000

出　　处：《重庆医学》2023年第20期3154-3158,3165,共6页Chongqing medicine

基　　金：四川省科技厅项目(2022NSFSC1534)。

摘　　要：目的比较关节镜下复位双排锚钉缝线桥固定和切开复位内固定治疗移位肱骨大结节骨折(HGTF)的临床效果。方法检索PubMed、Cochraney library、Web of Science、Embase、Medline、维普、知网、万方等数据库,检索时间为建库至2022年11月。根据纳入和排除标准筛选文献,提取数据,评估文献中的偏倚风险。使用RevMan 5.2软件对纳入文献进行meta分析,主要指标包括肩关节活动度、功能评分和并发症等。结果纳入文献6篇共304例患者,其中关节镜组140例,切开组164例;5篇为回顾性队列研究,1篇为随机对照研究,文献质量高。meta分析显示,关节镜组末次随访的肩关节前屈活动度(MD=20.27,95%CI:16.45~24.98)、外展活动度(MD=22.65,95%CI:17.41~27.89)、内旋活动度(MD=8.98,95%CI:4.59~13.37)均优于切开组(P<0.05),美国肩肘外科协会(ASES)评分(MD=4.09,95%CI:1.69~6.49)高于切开组(P<0.05),并发症发生率(OR=0.05,95%CI:0.01~0.23)低于切开组(P<0.05),视觉模拟量表(VAS)评分(MD=-0.49,95%CI:-0.73~-0.24)低于切开组(P<0.05),手术时间(MD=32.17,95%CI:27.16~37.18)长于切开组(P<0.05)。两组后伸活动度(MD=1.01,95%CI:-1.89~3.92)和外旋活动度(MD=2.46,95%CI:0.03~4.89)无明显差异(P>0.05)。结论关节镜下复位双排锚钉缝线桥固定治疗移位HGTF的近期效果较好,功能恢复好,并发症少。Objective To compare the clinical effects of arthroscopic double-row anchored suture bridge and open reduction and internal fixation in the treatment of HGTF.Methods We searched the database including of PubMed,Web of science,Medline,Embase,Cochraney library,CNKI,Wanfang and VIP,and the search time was established until November 2022.Studies were screened for inclusion and exclusion,data were extracted,and studies were assessed for risk of bias.The literatures were meta-analyzed using RevMan 5.2 software,including shoulder range of motion,functional scores,and complications.Results A total of 304 patients were included in 6 articles,including 140 cases in the arthroscopic group and 164 cases in the incision group;Five were retrospective cohort studies and one was a randomised controlled study with high quality.Meta-analysis showed that the shoulder flexion(MD=20.27,95%CI:16.45-24.98),abduction(MD=22.65,95%CI:17.41-27.89),internal rotation(MD=8.98,95%CI:4.59-13.37),American shoulder and elbow surgery(ASES)score(MD=4.09,95%CI:1.69-6.49),complications(OR=0.05,95%CI:0.01-0.23)and visual analogue(VAS)score(MD=-0.49,95%CI:-0.73 to-0.24)of the arthroscopy group were significantly better than the incision group(P<0.05).The operation time of the arthroscopy group[MD=32.17,95%CI:27.16-37.18]was significantly longer than that of the incision group(P<0.05).The difference between the extension(MD=1.01,95%CI:-1.89-3.92)and the external rotation(MD=2.46,95%CI:0.03-4.89)of two groups were no significant significance(P>0.05).Conclusion The arthroscopic double-row anchor suture bridge has a definite short-term effect on the treatment of HGTF,with good joint function recovery and fewer complications.

关 键 词：肱骨大结节 骨折 钢板 关节镜 双排锚钉 META分析 

分 类 号：R683[医药卫生—骨科学]