锁定钢板内固定与人工肱骨头置换治疗复杂肱骨近端骨折的Meta分析

Meta-analysis of locking plate fixation versus hemiarthroplasty for the treatment of complex proximal humeral fractures

目的系统评价切开复位锁定钢板内固定和人工肱骨头置换治疗复杂肱骨近端骨折的疗效差异。方法计算机检索Cochrane图书馆、Ovid、Pubmed、Oalib、中国生物医学文献、维普全文等数据库,检索1990—2013年的有关锁定钢板切开复位内固定和人工肱骨头置换治疗复杂肱骨近端骨折的文献资料。比较两者的Constant-Murley评分、并发症及二次手术率。对数据进行异质性检验,用Meta分析方法进行数据处理,估计相对危险度及其95%CI和标准均数差及其95%CI。结果共纳入10个队列研究(579例)进行研究,结果显示锁定钢板内固定与人工肱骨头置换在Constant-Murley评分[标准均数差(SMD)=0.67;95%CI(0.23,1.1);P=0.003]和二次手术率[RR=2.90;95%CI(1.69,4.99);P=0.0001]方面的差异有统计学意义,在并发症方面两者无统计学意义[RR=1.51;95%CI(0.98,2.31);P=0.06]。结论与人工肱骨头置换相比,锁定钢板治疗复杂肱骨近端骨折可获得更好的功能,但二次手术率较高。

Objective To compare the clinical outcomes of locking plate fixation versus hemiarthroplasty in the treatment of the complex proximal humeral fractures.Methods The Cochrane library,Ovid,Pubmed,and Oalib were searched for studies published between 1990 and 2013 reporting outcomes of the treatment of the complex proximal humeral fractures.We selected available trials that compared locking plate fixation and hemiarthroplasty in patients with proximal humeral fractures.Constant-Murley score,complications,and reoperation rates were compared.The heterogeneity was tested and the data was proceeded by Meta-analysis.Then,We calculated the RR value,standard mean difference and the 95% confidence interval.Results A total of 579 patients from 10 trials were included in this Meta-analysis.There was no statistical difference between locking plate fixation and hemiarthroplasty in aspect of complications.The patients with locking plate fixation had better Constant-Murley score and higher rate of reoperation than those with hemiarthroplasty.Conclusion Compared with hemiarthroplasty,patients with locking plate fixation could obtain more favorable functional outcomes and similar complications,but higher reoperation rates.