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华西医学  2015 

老年肱骨近端三、四部分骨折手术与保守治疗的Meta分析

DOI: 10.7507/1002-0179.20150631, PP. 2040-2045

Keywords: 肱骨近端骨折,保守治疗,手术治疗,老年,Meta分析

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Abstract:

目的?评估老年性肱骨近端3、4部分骨折手术与保守治疗的疗效,以期为临床上治疗方式的选择提供参考。方法?检索中国知网(1979年1月-2014年4月)、万方数据库(1982年1月-2014年4月)、Medline(1946年1月-2014年4月)、PubMed(1966年1月-2014年4月)、Embase(1974年1月-2014年4月)、CochraneDatabaseofSystematicReviews(2005年1月-2014年4月)等数据库中关于老年肱骨近端3、4部分骨折手术与非手术治疗疗效比较的随机对照研究(RCT),纳入符合标准的文献,提取相关数据输入RevMan5.2软件进行统计学分析。结果?5篇文献共计226例患者被纳入研究,Meta分析结果显示,手术组与非手术组Constant评分差异无统计学意义WMD=0.48分,95%CI(?4.39,5.35)分,P=0.85,后期肱骨头缺血性坏死(ANV)发生率差异无统计学意义RR=0.66,95%CI(0.37,1.16),P=0.15,骨折不愈合发生率差异无统计学意义RR=0.56,95%CI(0.20,1.58),P=0.27,骨关节炎发生率差异无统计学意义RR=0.35,95%CI(0.10,1.22),P=0.10;手术组再次手术治疗的发生率高于非手术组,差异有统计学意义RR=3.52,95%CI(1.18,10.45),P=0.02。结论?老年肱骨近端3、4部分骨折在Constant评分,后期发生ANV、骨折不愈合及骨关节炎等方面手术组和非手术组结果无明显差异,但手术治疗后期再手术率高于非手术治疗。考虑手术会增加患者的创伤以及经济负担,故建议对此类患者应采用保守治疗方式为宜。

References

[1]  1 Sanders RJ, Thissen LG, Teepen JC, et al. Locking plate versus nonsurgical treatment for proximal humeral fractures: better midterm outcome with nonsurgical treatment[J]. J Shoulder Elbow Surg, 2011, 20(7): 1118-1124.
[2]  2 van den Broek CM, van den Besselaar M, Coenen JM, et al. Displaced proximal humeral fractures: intramedullary nailing versus conservative treatment[J]. Arch Orthop Trauma Surg, 2007, 127(6): 459-463.
[3]  3 Tingart M, B?this H, Bouillon B, et al. The displaced proximal humeral fracture: is there evidence for therapeutic concepts[J]. Chirurg, 2001, 72(11): 1284-1291.
[4]  4 Wijgman AJ, Roolker W, Patt TW, et al. Open reduction and internal fixation of three and four-part fractures of the proximal part of the humerus[J]. J Bone Joint Surg Am, 2002, 84-A(11): 1919-1925.
[5]  5 Platzer P, Thalhammer G, Oberleitner G, et al. Displaced fractures of the greater tuberosity: a comparison of operative and nonoperative treatment[J]. J Trauma, 2008, 65(4): 843-848.
[6]  6 Yüksel HY, Ylmaz S, Akahin E, et al. The results of nonoperative treatment for three- and four-part fractures of the proximal humerus in low-demand patients[J]. J Orthop Trauma, 2011, 25(10): 588-595.
[7]  7 Den Hartog D, De Haan J, Schep NW, et al. Primary shoulder arthroplasty versus conservative treatment for comminuted proximal humeral fractures: a systematic literature review[J]. Open Orthop J, 2010, 4: 87-92.
[8]  8 Ilchmann T, Ochsner PE, Wingstrand H, et al. Non-operative treatment versus tension-band osteosynthesis in three- and four-part proximal humeral fractures[J]. Int Orthop, 1998, 22(5): 316-320.
[9]  9 Lin J. Effectiveness of locked nailing for displaced three-part proximal humeral fractures[J]. J Trauma, 2006, 61(2): 363-374.
[10]  10 Monga P, Verma R, Sharma VK. Closed reduction and external fixation for displaced proximal humeral fractures[J]. J Orthop Surg (Hong Kong), 2009, 17(2): 142-145.
[11]  11 张天嵩, 钟文昭. 实用循证医学方法学[M]. 长沙: 中南大学出版社, 2012: 57.
[12]  12 Zyto K, Ahrengart L, Sperber A, et al. Treatment of displaced proximal humeral fractures in elderly patients[J]. J Bone Joint Surg Br, 1997, 79(3): 412-417.
[13]  13 Fjalestad T, Hole M, Hovden IA, et al. Surgical treatment with an angular stable plate for complex displaced proximal humeral fractures in elderly patients: a randomized controlled trial[J]. J Orthop Trauma, 2012, 26(2): 98-106.
[14]  14 Olerud P, Ahrengart L, Ponzer S, et al. Internal fixation versus nonoperative treatment of displaced 3-part proximal humeral fractures in elderly patients: a randomized controlled trial[J]. J Shoulder Elbow Surg, 2011, 20(5): 747-755.
[15]  15 Olerud P, Ahrengart L, Ponzer S, et al. Hemiarthroplasty versus nonoperative treatment of displaced 4-part proximal humeral fractures in elderly patients: a randomized controlled trial[J]. J Shoulder Elbow Surg, 2011, 20(7): 1025-1033.
[16]  16 Boons HW, Goosen JH, Van Grinsven S, et al. Hemiarthroplasty for humeral four-part fractures for patients 65 years and older: a randomized controlled trial[J]. Clin Orthop Relat Res, 2012, 470(12): 3483-3491.
[17]  17 Zyto K, Kronberg M, Brostr?m L?. Shoulder function after displaced fractures of the proximal humerus[J]. J Shoulder Elbow Surg, 1995, 4(5): 331-336.
[18]  18 Neer CS 2nd. Displaced proximal humeral fractures. Ⅱ. Treatment of three-part and four-part displacement[J]. J Bone Joint Surg Am, 1970, 52(6): 1090-1103.
[19]  19 Kristiansen B. Treatment of displaced fractures of the proximal humerus: transcutaneous reduction and Hoffmann’s external fixation[J]. Injury, 1989, 20(4): 195-199.
[20]  20 Esser RD. Open reduction and internal fixation of three- and four-part fractures of the proximal humerus[J]. Clin Orthop Relat Res, 1994(299): 244-251.
[21]  21 Moda SK, Chadha NS, Sangwan SS, et al. Open reduction and fixation of proximal humeral fractures and fracture-dislocations[J]. J Bone Joint Surg Br, 1990, 72(6): 1050-1052.
[22]  22 Handoll HH, Ollivere BJ, Rollins KE. Interventions for treating proximal humeral fractures in adults[J]. Cochrane Database Syst Rev, 2012(12): CD000434.

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