保守治疗、切开复位及经皮微创接骨板内固定和髓内钉固定治疗肱骨干骨折的网状Meta分析

Conservative treatment,open reduction,percutaneous minimally invasive plate internal fixation and intramedullary nail fixation in the treatment of humeral shaft fractures:a network meta-analysis

目的:肱骨干骨折治疗的主要方法有保守治疗、切开复位内固定、经皮微创接骨板内固定和髓内钉固定,但哪种是最佳的治疗方案仍不清楚。文章运用网状Meta分析,比较保守治疗、切开复位内固定、经皮微创接骨板内固定和髓内钉固定共4种干预措施治疗肱骨干骨折的疗效。方法:检索中国知网、万方、维普、中国生物医学文献数据库、Pub Med、EMbase、The Cochrane Library和Web of Science数据库关于肱骨干骨折治疗的随机对照试验,检索时限为自建库至2021年1月。采用Cochrane协作网推荐的"偏倚风险评估"工具评价纳入文献质量。采用Rev Man 5.4软件和Stata 15.0软件进行网状Meta的图形绘制和数据分析。结果:(1)共纳入23项随机对照试验,共1220例肱骨干骨折患者,对照组为保守治疗,试验组采用切开复位内固定、经皮微创接骨板内固定和髓内钉固定干预;(2)纳入文献质量评价结果显示5篇文献为高质量文献,其他18篇文献为低质量文献;(3)网状Meta排序结果显示:上肢DASH评分,切开复位内固定>保守>经皮微创接骨板内固定>髓内钉固定;肩关节CMS评分,切开复位内固定>经皮微创接骨板内固定>保守>髓内钉固定;骨不连发生率,经皮微创接骨板内固定>切开复位内固定>髓内钉固定>保守;骨折愈合时间,经皮微创接骨板内固定>髓内钉固定>切开复位内固定>保守;医源性桡神经损伤发生率,保守>经皮微创接骨板内固定>髓内钉固定>切开复位内固定;总并发症发生率:保守>经皮微创接骨板内固定>切开复位内固定>髓内钉固定;结论:目前4种修复方法的随机对照试验证据表明,切开复位内固定治疗肱骨干骨折后患者上肢功能与肩关节功能恢复效果最佳,缺点是并发症发生率相对较高。为确保该研究结果的可靠性,未来还需更多的高质量随机对照试验来验证。

OBJECTIVE:The main methods for the treatment of humeral shaft fractures are conservative treatment,open reduction and internal fixation,percutaneous minimally invasive plate internal fixation and intramedullary nail fixation,but the best treatment is still unclear.The network meta-analysis was used to compare the efficacy of conservative treatment,open reduction and internal fixation,percutaneous minimally invasive plate internal fixation and intramedullary nail fixation in the treatment of humeral shaft fractures.METHODS:A randomized controlled study on the treatment of humeral shaft fractures was searched in CNKI,Wangfang,VIP,Chinese BioMedical Literature Database,PubMed,EMbase,The Cochrane library and Web of Science.The search period was from inception to January 2021.The"bias risk assessment"tool recommended by Cochrane Collaboration Network was used to evaluate the quality of the literature.The RevMan 5.4 software and Stata 15.0 software were used to draw the graph and analyze the data of the network Meta.RESULTS:(1)A total of 23 randomized controlled trials were included.A total of 1220 patients with humeral shaft fractures were divided into experimental group and control group.The control group was treated conservatively,and the experimental group was treated with open reduction and internal fixation,percutaneous minimally invasive plate internal fixation and intramedullary nail fixation.(2)Literature quality evaluation was included:5 articles were of high quality and the other 18 were of low quality.(3)In terms of DASH score,the order of network Meta was as follows:open reduction and internal fixation>conservative>percutaneous minimally invasive plate internal fixation>intramedullary nail fixation.In terms of CMS score,the order of network Meta was as follows:open reduction and internal fixation>percutaneous minimally invasive plate internal fixation>conservative>intramedullary nail fixation.In terms of bone nonunion,the order of network Meta was as follows:percutaneous minimally invasive plate internal fixation>open reduction internal fixation>intramedullary nail fixation>conservative treatment.In terms of fracture healing time,the order of network Meta was as follows:percutaneous minimally invasive plate internal fixation>intramedullary nail fixation>open reduction and internal fixation>conservative.The network Meta order of iatrogenic radial nerve injury was conservative>percutaneous minimally invasive plate fixation>intramedullary nail fixation>open reduction and internal fixation.The order of total complications of network Meta was conservative>percutaneous minimally invasive plate internal fixation>open reduction and internal fixation>intramedullary nail fixation.CONCLUSION:A comprehensive analysis of the results of the network meta-analysis of the four intervention measures showed that the upper limb function DASH score and shoulder CMS score of the affected limb after open reduction and internal fixation were the best,but the incidence of complications was relatively high.More high-quality randomized controlled trials are needed to ensure the reliability of the results.