肱骨干骨折后桡神经麻痹的系统评价

Systematic review of radial nerve palsy associated with humeral shaft fracture

目的采用循证医学研究方法,系统评价肱骨干骨折后桡神经麻痹(radialnervepalsy,RNP)的不同处理方法,为临床治疗决策提供证据基础。方法采用PubMed、Datastar及CochraneDatabase等互联网公共搜索引擎作为检索工具,检索过去40年中发表的有关肱骨干骨折后桡神经麻痹的文献,再对入选文献的参考文献行手工检索,制定数据抽取问表,对入选文献进行数据抽取、汇总、归纳和荟萃分析。结果共检索到391篇原始文献,其中324篇得自电子检索,67篇得自手工检索。有35篇符合最终的入选标准,总计随访患者1045例。其中21篇文献共记录了发生于4517例肱骨干骨折中的532例桡神经麻痹,肱骨干骨折后桡神经麻痹的发生率为11.8%。肱骨干中1/5和中远1/5部位的桡神经麻痹发生率明显高于其他部位(P<0.05)。不同骨折类型中,横形和螺旋形骨折较斜形和粉碎性骨折更易于并发桡神经麻痹(P<0.0001)。肱骨干骨折后桡神经麻痹总的恢复率为88.1%,早期保守治疗的病例自发性恢复率为70.7%。观察等待组和早期手术探查组之间神经恢复的最终结果没有明显差别。结论对肱骨干骨折后桡神经麻痹采用早期保守治疗不会影响神经的最终恢复结果,可以避免许多不必要的手术。

Objective To review the clinical management of the radial nerve palsy （RNP） associated with humeral shaft fractures via systematically reviewing the published available articles, and develope an algorithm to guide management for RNP. Methods Using PubMed, Datastar and Cochrane Database, web based databases were searched for radial nerve palsy associated with humeral shaft fractures in the past 40 years, and manual searches of the bibliographic sections of electronically identified papers were done to identify further papers. Meticulous data extraction and meta-analysis was performed according to a preset protocol..Results In 391 citations initially identified, 35 papers, which included a total of 1045 RNP patients, met all eligibility criteria. The overall RNP incidence after humeral shaft fractures in 21 papers was 11.8% （532/4517）. The incidence of RNP in middle 1/5 and middle-distal 1/5 of the humeral shaft fracture was significantly higher than that in other parts. Transverse and spiral fractures were more likely to sustain RNP than oblique and eomminuted fracture patterns （P 〈 0.0001）. The overall recovery rate of RNP was 88.1%, with a general rate of spontaneously recovery reaching 70.7% in conservatively treated patients. There was no significant difference in the final recoverv results when comparing groups initially managed expectantly with those explored early. Conclusion Initial conservative treatment of RNP associated with humeral shaft fracture would not adversely affect the extent of nerve recovery and could avoid many unnecessary operations.