锁定钢板与人工肱骨头置换治疗成人肱骨近端骨折疗效的Meta分析

Meta- analysis on efficacy of locking plate versus shoulder hemiarthroplasty in treatment of adult proximal humeral fractures

目的对采取锁定钢板与人工肱骨头置换治疗成人肱骨近端骨折的临床疗效进行Meta分析，探讨两种手术方式的治疗效果。方法通过计算机检索中国生物医学文献数据库（CBM）、中文万方数据库、维普数据库（VIP）、中国知网（CNKU及外文PubMed、ScienceDirect等数据库2004年1月至2013年12月期间发表的相关治疗肱骨近端骨折的各种对照研究，进行Meta分析。结果共纳入符合标准的文献9篇，采用ReviewManager5．2软件进行Meta分析，结果显示：锁定钢板与人工肱骨头置换比较Neer评分优良率方面差异无统计学意义（OR=0．84，95％CI：0．33—2．14，P=0．72），在ASES评分优良率方面无显著差异（OR=0．80，95％CI：0．26～2．44，P=0．69）。结论目前认为锁定钢板与人工肱骨头置换对特定骨折类型各有利弊。对于高龄粉碎性的肱骨近端骨折患者，多数倾向于人工肱骨头置换。对于老年粉碎性的肱骨近端骨折的患者．现有文献中没有足够的对照试验证明人工肱骨头置换的优越性。

Objective To explore the clinical efficacy of locking plate versus shoulder hemiarthroplasty in treatment of adult proximal hu- meral fractures and to compare the therapeutic effect of these two surgical procedures with Meta - analysis. Methods Retrieving CBM data via a computer, Chinese Wan Fang data, VIP database, CNKI and foreign PubMed, Science Direct and other databases during the period of January 2004 to December 2013, various control studies published systematic evaluation related to proximal humeral fractures were collected and analyzed. Results Meta - analysis had been performed in a total of nine standard literatures by using Review Manager 5.2 software, the results showed that locking plate versus shoulder hemiarthroplasty was not significantly different in comparison with Neer rated excellent rate （OR = 0.84, 95% CI： 0. 33 -2.14, P =0.72） in ASES score good rate （OR =0.80, 95% CI： 0.26 -2.44, P =0.69）. Conclusion Currently, the locking plate with shoulder hemiarthroplasty for specific fracture type has advantages and disadvantages. For elderly patients with comminuted proximal humeral fracture, the majority are tend to shoulder hemiarthroplasty, but the existing literatures have not enough controlled trials to prove the superiority of shoulder hemiarthroplasty .