肱骨近端锁定接骨板/肱骨近端内锁定系统和人工肱骨头置换治疗成年人肱骨近端骨折的疗效比较

LPHP/PHILOS versus shoulder hemiarthroplasty for the treatment of proximal humeral fractures in adults: a systematic review

背景:成人肱骨近端骨折,尤其是三、四部分骨折,采用何种治疗方案仍有争论。目的:对采用肱骨近端锁定接骨板/肱骨近端内锁定系统(LPHP/PHILOS)与人工肱骨头置换治疗成年人肱骨近端骨折(proximal humeral fracture,PHF)的临床疗效进行系统评价。方法:检索Ovid Medline和Pub Med(2001年1月至2011年12月)、Embas(e2001年1月至2011年12月)、Cochrane Cen-tral Register of Controlled Trial(s2011年)、中国生物医学文献数据库(CBM,2001年1月至2011年12月)等数据库,搜集全部有关LPHP/PHILOS治疗肱骨近端骨折的各种对照研究,进行系统评价。结果:LPHP/PHILOS与其他内固定治疗成人肱骨近端骨折的系统评价共纳入7个非随机对照试验及1个半随机对照试验,8个研究均为C级。资料分析结果显示:人工肱骨头置换与LPHP/PHILOS比较Neer评分优良率无显著性差异[OR=1.27,95%C(I0.34,4.71),P=0.72];术后其他并发症发生率及二次手术发生率差异无统计学意义。结论:目前认为LPHP/PHILOS与人工肱骨头置换针对特定年龄及特定骨折类型人群各有利弊。对于高龄粉碎性肱骨近端骨折患者(75岁,三/四部分骨折)大部分医生倾向于人工肱骨头关节置换。对于老年骨质疏松性肱骨近端骨折患者,现有文献中没有足够的对照实验证明LPHP/PHILOS相对与人工肱骨头置换的优越性。

Background： The therapy of proximal humeral fractures （PHFs） in adults, especially for 3-or 4-part fractures, is still uncertain for traumatology surgeon. Objective： The aim of the study is to systematically review the outcomes of locking proximal humerus plate/proximal humeral internal locking system （LPHP/PHILOS） versus shoulder hemiarthroplasty for the treatment of PHFs in adults. Methods： According to Cochrane systematic review, Cochrane library, Medline, Embase, CNKI, VIP and Chinese Biomedical Database were retrieved for randomized controlled trials （RCTs）, Quasi-RCTs and Non-RCTs comparing relevant interventions for the treatment of PHFs with LPHP/PHILOS versus shoulder hemiarthroplasty in adults. Results： Seven Non-RCTs and one Quasi-RCTs were included in this systematic review. For methodology quality, all of them were C-scale trials. There were no significant differences in the excellent and good rates of Neer between LPHP/PHILOS and shoulder hemiarthroplasty （OR=1.27, 95%CI： [0.34, 4.71], P=0.72）. Neither were the incidences of complications and secondary operation between the two methods. Conclusions： There are pro and con in the treatment of PHFs by LPHP/PHILOS or shoulder hemiarthroplasty. For the elderly patients of PHFs （75years, 3 or 4-part fractures）, most surgeons prefers shoulder hemiarthroplasty. The current literature offers no robust evidence to support LPHP/PHILOS is superior to shoulder hemiarthroplasty for PHFs.