| 锁定钢板结合异体腓骨支撑与单独锁定钢板固定治疗肱骨近端骨折疗效的Meta分析 |
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投稿时间：2020-06-04
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| 作者 | Author | 单位 | Address | E-Mail |
| 唐迪 |
TANG Di |
重庆医科大学附属第二医院骨科, 重庆 400010 |
Department of Orthopaedics, the Second Affiliated Hospital of Chongqing Medical University, Chongqing 400010, China |
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| 钟鸿志 |
ZHONG Hong-zhi |
重庆医科大学附属第二医院骨科, 重庆 400010 |
Department of Orthopaedics, the Second Affiliated Hospital of Chongqing Medical University, Chongqing 400010, China |
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| 梁凯路 |
and LIANG Kai-lu |
重庆医科大学附属第二医院骨科, 重庆 400010 |
Department of Orthopaedics, the Second Affiliated Hospital of Chongqing Medical University, Chongqing 400010, China |
liang-kai-lu@163.com |
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| 期刊信息：《中国骨伤》2022年，第35卷，第2期，第186-193页 |
| DOI：10.12200/j.issn.1003-0034.2022.02.018 |
| 基金项目: |
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中文摘要:
目的：Meta分析比较锁定钢板结合同种异体腓骨支撑（FA组）与单独锁定钢板固定（LP组）治疗成人肱骨近端骨折的临床疗效。
方法：计算机检索建库至2020年3月PubMed，The Cochrane Library，Embase，中国生物医学数据库（Chinese BioMedical Literature Database，CBM），中国期刊全文数据库（China National Knowledge Infrastructure，CNKI），万方数据库及维普中文科技期刊数据库关于锁定钢板结合同种异体腓骨支撑与单独使用锁定钢板内固定治疗成人肱骨近端骨折的相关文献。由2名研究者独立筛选文献，提取资料并评价纳入研究的偏倚风险，采用RevMan 5.3软件对术后肱骨头高度丢失，肱骨颈干角改变，肩关节Constant-Murley评分，美国肩肘外科医生（American Shoulder and Elbow Surgeons，ASES）评分，视觉模拟评分（visual analogue scale，VAS），肱骨头内翻畸形率，肱骨头坏死率及术后螺钉穿出率进行Meta分析。
结果：共纳入10个研究，均为队列研究，共749例患者，其中FA组300例，LP组449例。Meta分析结果显示：锁定钢板结合同种异体腓骨支撑与单独锁定钢板固定在肱骨头高度丢失[MD=-2.69，95% CI（-3.24，-2.13），P<0.000 01]，颈干角改变[MD=-5.65，95% CI（-7.18，-4.12），P<0.000 01]，Constant-Murley评分[MD=9.00，95% CI（4.26，13.73），P=0.000 2]，ASES评分[MD=5.56，95% CI（4.29，6.84），P<0.000 01]，VAS评分[MD=-0.23，95% CI（-0.37，-0.09），P=0.001]，肱骨头内翻发生率[RR=0.22，95% CI（0.09，0.53），P=0.000 7]，螺钉穿出率[RR=0.26，95% CI（0.13，0.55），P=0.000 3]方面比较差异有统计学意义，但两组在肱骨头坏死率方面比较差异无统计学意义[RR=1.18，95% CI（0.57，2.45），P=0.65]。
结论：对于成人不稳定肱骨近端骨折，与单独锁定钢板内固定相比，锁定钢板结合同种异体腓骨髓内支撑治疗能够改善术后影像学和肩关节功能，减少术后疼痛，降低术后肱骨头内翻畸形率和螺钉穿出率，但在降低术后肱骨头坏死率方面效果尚不确切。受纳入研究质量和数量的影响，本研究结论还需更多高质量的随机对照研究证实。 |
| 【关键词】近端肱骨骨折 骨移植 骨板 Meta分析 |
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| Locking plate fixation with fibular strut allograft versus locking plate fixation alone for the treatment of proximal humeral fractures in adults: a Meta-analysis |
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ABSTRACT
Objective: To compare the clinical efficacy of locking plate fixation with a fibular strut allograft (FA group) and locking plate fixation alone (LP group) in the treatment of proximal humeral fractures in adults by Meta-analysis.
Methods: Databases including PubMed,The Cochrane Library,Embase,Chinese BioMedical Literature Database(CBM),China National Knowledge Infrastructure(CNKI),WanFang Data,and China Science and Technology Journal Database (cpvip Database) were searched by computer from establishing to March 2020 to collect studies about locking plate fixation with fibular strut allograft versus locking plate fixation alone for proximal humeral fractures in adults. Two reviewers independently screened literature,extracted data,and assessed the risk of bias of included studies. The postoperative humeral head height changes,neck-shaft angle changes,Constant-Murley score,American Shoulder and Elbow Surgeons(ASES)score,visual analogue scale(VAS),varus malunion rate,and screw penetration rate were compared by RevMan 5.3 software for Meta-analysis.
Results: Ten cohort studies were enrolled in a total of 749 patients,300 patients in the FA group and 449 patients in the LP group. The results of Meta-analysis showed that locking plate with fibular strut allograft was superior to locking plate fixation alone in the changes in humeral head height[MD=-2.69,95% CI(-3.24,-2.13),P<0.000 01],the changes in neck-shaft angle[MD=-5.65,95% CI(-7.18,-4.12),P<0.000 01],Constant-Murley score[MD=9.00,95% CI(4.26,13.73),P=0.000 2],the ASES score[MD=5.56,95% CI(4.29,6.84),P=0.000 01],VAS score[MD=-0.23,95% CI(-0.37,-0.09),P=0.001],the varus malunion rate[RR=0.22,95% CI(0.09,0.53),P=0.000 7] and the screw penetration rate[RR=0.26,95% CI(0.13,0.55),P=0.000 3],respectively.While there was no significant difference in the rate of osteonecrosis of the humeral head[RR=1.18,95% CI(0.57,2.45),P=0.65].
Conclusion: For proximal humeral fractures in adults,current evidence shows that locking plate fixation with fibular strut allograft is superior to single locking plate fixation in improving postoperative radiological outcomes and shoulder function,relieving postoperative pain,reducing varus malunion rate and screw penetration rate. However,the efficacy in decreasing the osteonecrosis rate is not clear. Due to limited quality and quantity of the included studies,more high-quality studies are required to verify the above conclusion. |
| KEY WORDS Proximal humeral fractures Bone transplantation Bone plates Meta-analysis |
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| 引用本文，请按以下格式著录参考文献： |
| 中文格式: | 唐迪,钟鸿志,梁凯路.锁定钢板结合异体腓骨支撑与单独锁定钢板固定治疗肱骨近端骨折疗效的Meta分析[J].中国骨伤,2022,35(2):186~193 |
| 英文格式: | TANG Di,ZHONG Hong-zhi,and LIANG Kai-lu.Locking plate fixation with fibular strut allograft versus locking plate fixation alone for the treatment of proximal humeral fractures in adults: a Meta-analysis[J].zhongguo gu shang / China J Orthop Trauma ,2022,35(2):186~193 |
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