手术和非手术治疗老年人肱骨近端三、四部分骨折疗效的meta分析

目的：采用meta分析方法评价手术和非手术治疗老年人肱骨近端三、四部分骨折的临床疗效。方法：计算机检索Cochrane Library、Medline、Embase、中国生物医学文献数据库、中国知网、万方数据和维普数据库中关于手术和非手术治疗老年人肱骨近端三、四部分骨折疗效的文献，并手动检索重要骨科学会会议摘要。对纳入的文献进行方法学质量评价，并以肩关节功能Constant评分、远期疼痛、股骨头缺血性坏死（AVN）发生率、再手术率、骨关节炎发生率、骨不连发生率作为评价指标，采用RevMan 5.3软件进行meta分析。结果：最终纳入6篇文献，共264例患者。meta分析结果显示，手术治疗后患者与非手术治疗后患者肩关节功能Constant评分（MD=0.47，95%CI：-4.35~5.28，P=0.85）、AVN发生率（OR=0.56，95%CI：0.25~1.24，P=0.15）、骨关节炎发生率（OR=0.56，95%CI：0.19~1.68，P=0.30）、骨不连发生率（OR=0.43，95%CI：0.13~1.43，P=0.17）差异无统计学意义，远期疼痛评分手术治疗组优于非手术治疗组（MD=1.01，95%CI：0.12~1.19，P=0.03），再手术率手术治疗组高于非手术治疗组（OR=3.97，95%CI：1.45~10.92，P=0.007）。结论：现有文献表明，老年人肱骨近端三、四部分骨折手术治疗与非手术治疗在患者肩关节功能Constant评分、AVN发生率、骨关节炎发生率、骨不连发生率方面无差异，但需大规模、高质量的研究进一步证实。
Abstract: Objective: To evaluate the efficacy of operative and non-operative treatment for three- or four-part proximal humeral fractures in elderly patients by meta-analysis. Methods: The literature search was performed in Cochrance Library, Medline, Embase, SinoMed, CNKI, Wanfang data and CQVIP databases for operative and non-operative treatment of three- or four-part proximal humeral fractures in elderly patients, and searches of conference proceedings were also conducted. The data were extracted and a meta-analysis was performed using RevMan 5.3. The outcome measures included Constants score, pain and incidence rates of AVN, reoperation, osteoarthritis, nonunion. Results: Six randomized controlled trials involving 264 patients were included in the meta-analysis. The differences of Constant scores (MD=0.47, 95% CI:-4.35-5.28, P=0.85), incidence of ANV (OR=0.56, 95% CI:0.25-1.24, P=0.15), incidence of osteoarthritis (OR=0.56, 95% CI:0.19-1.68, P=0.30), incidence of nonunion (OR=0.43, 95% CI:0.13-1.43, P=0.17) between operative group and non-operative group were not statistically significant. Operative treatment was better in pain score (MD=1.01, 95% CI:0.12-1.19, P=0.03) and had statistically significant higher reoperative rate (OR=3.97, 95% CI:1.45-10.92, P=0.007). Conclusions: No evidence support that there is difference in Constant score and incidence rate of ANV, osteoarthritis, nonunion between operative and non-operative treatment for three- or four-part proximal humeral fractures in elderly patients. More high quality randomized controlled trials are required to determine which treatment is more efficient. Key words: Meta-analysis Shoulder fractures/surgery Manipulation, orthopedic Aged Fracture fixation Treatment outcome