手术与非手术治疗肱骨近端骨折疗效比较的Meta分析

Operative versus nonoperative treatment for proximal humeral fractures: a meta-analysis

[目的]通过Meta分析对手术与非手术治疗肱骨近端骨折的疗效进行比较,为临床治疗的选择提供循证学证据。[方法]利用计算机检索电子数据库Pub Med,MEDLINE,EMBASE,CINAHL和Cochrane Register,万方数据库、中国知识资源总库和维普数据库,检索时间为1970年1月~2015年9月,收集关于手术与非手术治疗肱骨近端骨折疗效对比的的临床试验,按照特定的纳入与排除标准筛选出文献并进行质量评价,采用Rev Man 5.2软件对各个临床观察指标进行统计学分析。[结果]共纳入12篇文献,总计857例患者,手术组480例,非手术组377例。Meta分析表明,在EQ-5D评分方面两组之间的差异具有统计学意义（P〉0.05）;在DASH评分方面,非手术组优于手术组;在Constant评分方面,手术组优于非手术组,两组之间的差异具有统计学意义（P〈0.05）。在治疗后并发症、再次手术率方面,非手术组较手术组低（P〈0.05）。[结论]与手术治疗相比,非手术治疗能给患者带来更少的并发症,同时也降低了再次手术的风险。根据现有证据,无法判断非手术治疗在临床功能方面有优越性。由于样本量较小,本结论仍需要更多高质量的临床研究来验证。

[ Objective] To compare the curative effects of operative vs nonoperative treatment for proximal humeral fractures through Meta analysis. [ Method ] Eligible studies were identified from electronic databases, including PubMed, Medline, EMBASE,CINAHL,the Cochrane Library, Cochrane Register, CNKI,Wanfang Data and VIP from January 1970 to September 2015, and then screend out according to the inclusion and exclusion criteria. A meta -analysis was performed using the software RevMan 5.2 after identification of the relevant data. [ Result] Twelve studies including 857 patients （ operation group, n = 480 ; nonoperation group, n = 377）fulfilled our inclusion criteria. A test of heterogeneity proved no difference in these studies. There were no significant differences, from the result of EQ -5D Scores analysis, between operation group and nonoperation group （P 〉 0.05 ）. The DASH scoring result in nonoperation group was better than that of operation group, while the Constant scoring result was better in operation group than that of nonoperation group, both with significant difference（P 〈 0.05 ）. In terms of postopera- tive complicaitons and second operation rate, the nonoperation group was superior to operation group （P 〈 0.05 ）. [ Conclusion ] Compared with operative treatment, nonoperative treatment provides less complications and less additional surgery risks. Howev- er, it still remains controversial which treatment has better clinical outcomes. The current sample size in this study is still small, therefore, more high - quality,large sample clinical trials are needed to support our conclusion.