手术和非手术治疗老年人肱骨近端三、四部分骨折疗效的meta分析

Operative versus non-operative treatment for three-or fourpart proximal humeral fractures in elderly patients:a metaanalysis of randomized controlled trials

目的：采用meta分析方法评价手术和非手术治疗老年人肱骨近端三、四部分骨折的临床疗效。方法：计算机检索CochraneLibrary、Medline、Embase、中国生物医学文献数据库、中国知网、万方数据和维普数据库中关于手术和非手术治疗老年人肱骨近端三、四部分骨折疗效的文献，并手动检索重要骨科学会会议摘要。对纳入的文献进行方法学质量评价，并以肩关节功能Constant评分、远期疼痛、股骨头缺血性坏死（AVN）发生率、再手术率、骨关节炎发生率、骨不连发生率作为评价指标，采用RevMan5．3软件进行meta分析。结果：最终纳入6篇文献，共264例患者。meta分析结果显示。手术治疗后患者与非手术治疗后患者肩关节功能Constant评分（MD=0．47，95％CI：-4．35-5．28，P=0．85）、AVN发生率（OR=0．56，95％CI：0．25-1．24，P=0．15）、骨关节炎发生率（OR=0．56，95％CI：0．19-1．68，P=0．30）、骨不连发生率（OR=0．43，95％CI：0．13-1．43，P=0．17）差异无统计学意义，远期疼痛评分手术治疗组优于非手术治疗组（MD：1．01，95％CI：0．12-1．19，P=0．03），再手术率手术治疗组高于非手术治疗组（OR=3．97，95％CI：1．45-10．92，P=0．007）。结论：现有文献表明，老年人肱骨近端三、四部分骨折手术治疗与非手术治疗在患者肩关节功能Constant评分、AVN发生率、骨关节炎发生率、骨不连发生率方面无差异，但需大规模、高质量的研究进一步证实。

Objective： To evaluate the efficacy of operative and non-operative treatment for three- or four-part proximal humeral fractures in elderly patients by meta- analysis. Methods： The literature search was performed in Cochrance Library, Medline, Embase, SinoMed, CNKI, Wanfang data and CQVIP databases for operative and non-operative treatment of three- or four-part proximal humeral fractures in elderly patients, and searches of conference proceedings were also conducted. The data were extracted and a meta-analysis was performed using RevMan 5.3. The outcome measures included Constants score, pain and incidence rates of AVN, reoperation, osteoarthritis, nonunion. Results： Six randomized controlled trials involving 264 patients were included in the recta-analysis. The differences of Constant scores （ MD = 0.47, 95% CI： -4.35 -5.28, P =0.85） , incidence of ANV （OR =0.56, 95% CI：0. 25 - 1.24, P = 0.15 ）, incidence of osteoarthritis （ OR = 0.56, 95% CI：0. 19 - 1.68, P = 0.30）, incidence of nonunion （OR =0.43, 95% CI：0. 13 - 1.43, P =0. 17） between operative group and non-operative group were not statistically significant. Operative treatment was better in pain score （MD = 1.01, 95% CI：0. 12 - 1.19, P = 0.03） and had statistically significant higher reoperative rate （ OR = 3.97, 95% CI： 1.45 - 10.92, P = 0. 007 ）. Conclusions： No evidence support that there is difference in Constant score and incidence rate of ANV, osteoarthritis, nonunion between operative and non-operative treatment for in elderly patients. More high quality three- or four-part proximal humeral fractures randomized controlled trials are required to determine which treatment is more efficient.