摘要
目的比较髓内钉和钢板两种内固定治疗肱骨近端骨折的安全性、有效性及差异性。方法计算机检索Pub Med、CENTRAL、EMbase、the ISI Web of Knowledge Databases、VIP、CNKI、CBM和万方数据库,查找所有比较髓内钉和钢板钢板治疗肱骨近端骨折的随机对照试验(RCT)及临床对照试验(CCT),检索时限均为建库至2015年12月31日。同时手检纳入文献的参考文献。按纳入排除标准由两人独立进行筛选、资料提取和质量评价后,采用Rev Man5.3软件进行Meta分析。结果共纳入14个研究,1010例患者。Meta分析结果显示:与钢板相比,髓内钉治疗手术时间更短[MD=-23.04,95%CI(-28.47,-17.60),P<0.1]、术中出血量较少[SMD=-3.14,95%CI(-4.21,-2.08),P<0.1]、骨折愈合时间更短[SMD=-3.03,95%CI(-3.77,-2.28),P<0.1],总的并发症无统计学意义[RR=0.38,95%CI(0.25,0.57),P=0.24];然而,ASES评分显示钢板组优于髓内钉组[SMD=-0.63,95%CI(-0.98,-0.28),P<0.1],Costant-Murley评分差异无统计学意义[SMD=-0.05,95%CI(-0.21,0.11),P>0.1],末次随访时颈干角差异无统计学意义[MD=0.09,95%CI(-0.22,0.40),P>0.1],末次随访时Neer征差异无统计学意义[RR=0.51,95%CI(0.25,1.03),P<0.1]。结论本系统研究发现,总体而言,治疗肱骨近端骨折时,髓内钉优于钢板。但这一结论仍然需要大样本、高质量的研究及采用关键性指标,进行进一步的论证。
Objective To objectively evaluate the efficacy and safety of plate versus Intramedullary nailing in treating Proximal humerus fractures. Methods Such databases as PubMed, Cochrane Central Register of Controlled Trials （CEN- TRAL）, EMbase, the IS1 Web of Knowledge databases, VIP, CNKI, CBM and Wanfang were searched from their es- tablishment to Dec 2015 for collecting the Controlled clinical trial about plate vs Intramedullary nailing in treating Proxi- mal humerus fractures, and the references ofthose trails were also searched by hand. Afler study selection, assessment and data extraction conducted by two reviewers independently, Meta-analyses were performed by using the RevMan 5.3 software. Results Fourteen studies involving 1010 patients were included. The results of recta-analyses showed that： compared with the plate, Intramedullary nailing had shorter operation time [MD= -23.04, 95 %CI （-28.47, -17.60）, P〈0.1], less intraoperative bleeding [SMD= -3.14, 95%CI （-4.21, -2.08）, P〈0.1], and shorter time needed in the mean healing time [SMD=-3.03,95 % CI （-3.77, -2.28）, P〈0.1 ], but there was no significant difference in the complications [RR=0.38, 95%CI （0.25, 0.57）, P=-0.24]; there was no significant difference in the function of shoulder joint of Costant-Murley evaluation [SMD= -0.05, 95 % CI （-0.210.11）, P〉0.1 ], however, there is a difference in the function of shoulder joint of ASES evaluation [SMD= -0.63, 95 %CI （-0.98, -0.28）, P〈0.1], and else, there is no difference intheVAS [MD=0.44, 95%C1 （-0.11, 0.98）, P〉0.1] and collodiaphyseal angle [MD=0.09, 95%CI （-0.22, 0.40）, P〉O. 1] in the end stage follow of the proximal humerus fractures. Conclusion Compare with the plate, the lntramedullary nailing is isbetter in treating proximal humerus fractures; for the limited quantity ofthe original studies, a prudent choice is suggested; and more high-quality, large-sample studies are need.
出处
《生物骨科材料与临床研究》
CAS
2016年第6期25-32,共8页
Orthopaedic Biomechanics Materials and Clinical Study
