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中华关节外科杂志(电子版) ›› 2019, Vol. 13 ›› Issue (03) : 320 -328. doi: 10.3877/cma.j.issn.1674-134X.2019.03.011

所属专题: 文献

荟萃研究

锁定钢板与半肩关节置换治疗中老年复杂肱骨近端骨折的Meta分析
陈剑1, 孙海飚2,(), 韩晓强2   
  1. 1. 030001 太原,山西医科大学
    2. 030001 太原,山西医科大学第一医院骨科
  • 收稿日期:2017-12-13 出版日期:2019-06-01
  • 通信作者: 孙海飚

Meta-analysis of locking plate versus hemiarthroplasty for complex proximal humeral fractures in middle-aged and elderly patients

Jian Chen1, Haibiao Sun2,(), Xiaoqiang Han2   

  1. 1. Shanxi Medical University, Taiyuan 030001, China
    2. Department of Orthopaedics, First Hospital of Shanxi Medical University, Taiyuan 030001, China
  • Received:2017-12-13 Published:2019-06-01
  • Corresponding author: Haibiao Sun
  • About author:
    Corresponding author: Sun Haibiao, Email:
引用本文:

陈剑, 孙海飚, 韩晓强. 锁定钢板与半肩关节置换治疗中老年复杂肱骨近端骨折的Meta分析[J/OL]. 中华关节外科杂志(电子版), 2019, 13(03): 320-328.

Jian Chen, Haibiao Sun, Xiaoqiang Han. Meta-analysis of locking plate versus hemiarthroplasty for complex proximal humeral fractures in middle-aged and elderly patients[J/OL]. Chinese Journal of Joint Surgery(Electronic Edition), 2019, 13(03): 320-328.

目的

通过Meta分析探讨锁定钢板(LP)及半肩关节置换(HA)治疗肱骨近端骨折(PHFs)术后并发症及疗效的差异。

方法

计算机检索Pubmed、Cochrane图书馆、EMBASE、ScienceDirect、中国知网、万方、维普等数据库。搜集有关LP/HA治疗PHFs的各种对照研究,纳入标准:随机或非随机对照试验;行LP和HA治疗;年龄≥ 45岁;随访时间>3个月;可提取到可靠的数据。排除标准:病例数少于10例;其他治疗方式;病例报告,综述,动物实验以及系统评价;多种原因不能耐受手术;病理性骨折或者肱骨近端陈旧性骨折;既往有肩关节外伤及手术病史。研究共纳入27项研究2 082例患者,对纳入的文献选择总并发症、常见并发症(肩关节不稳、关节僵硬、肩峰下撞击症)、术后功能评分(Constant-Murley肩关节评分系统、美国肩肘外科医师协会评分)作为Meta分析的评价指标,采用STATA 14.0分析,对于合并SMD 或者ORP <0.05差异有统计学意义。

结果

结果表明两组总并发症[OR =1.73,95%CI(1.35,2.21),P <0.01]、肩峰下撞击症[OR =0.25,95%CI(0.11,0.55),P<0.01]以HA组较低;上肢肌力评分[SMD=1.857,95%CI(0.803,2.912),P<0.01]、肩关节活动度评分[SMD=2.542,95%CI(1.273,3.811),P<0.01]以LP组较优。两组CMS、ASES评分差异无统计学意义(P >0.05)。

结论

HA术后并发症的发生率低于LP,两者均能获得相近的肩关节功能恢复。

Objective

To compare the compilications and outcomes of locking plate versus hemiarthroplasty in the treatment of proximal humeral fractures(PHFs) with meta-analysis.

Methods

Controlled clinical trials on LP/HA for the treatment of PHFs searched in Pubmed, the Cochrane Library, EMBASE, ScienceDirect, China National Knowledge Infrastructure, Wanfang, VIP Databas. Inclusion criteria: randomized or non-randomized controlled trials; LP and HA treatment; age ≥ 45 years old; follow-up time>three months; reliable data can be extracted. Exclusion criteria: the cases were less than 10; other treatment methods; case reports, reviews, animal experiments and systematic reviews; reasons cannot tolerate surgery; pathological fractures OR old fractures of the proximal humerus; history of shoulder injury and surgery. A total of 2 082 patients from 27 trials were included in this meta-analysis. STATA 14.0 was used to analyze the trials included in terms of total complications, common complications (shoulder instability, shoulder stiffness, subacromial impingement), postoperative functional scores, including Constant-Murley scores (CMS) and rating scales of American Shoulder and Elbow Surgeons (ASES) by meta-analysis. For combined SMD or OR, P<0.05 means significant difference.

Results

There were significant differences in total complications[OR =1.73, 95%CI(1.35, 2.21), P <0.01], subacromial impingement [OR =0.25, 95%CI(0.11, 0.55), P<0.01], which HA group were lower; while muscle strength of upper limbs score[SMD=1.857, 95%CI(0.803, 2.912), P<0.01], range of motion [SMD=2.542, 95%CI(1.273, 3.811), P<0.01], but not significant differences in CMS and ASES.

Conclusion

HA may have lower rate of overall incidence complications than LP, both of them could have similar shoulder function recovery.

表1 纳入文献的基本特征以及质量评价结果
研究&出版年限 地区 设计 组别 年龄 男/女 骨折类型 随访(月) 结果 NOS/Jadad
王德利 2009[6] China CCS LP 49 14/8 NeerⅢ:-NeerⅣ:- 21.6 NR 8
? ? ? HA 49 / NeerⅢ:-NeerⅣ:- 18.3 ? ?
章军辉 2010[7] China CCS LP 66.5±1.4 12/16 NeerⅢ:25 NeerⅣ:2 29.8 NR 8
? ? ? LP 68.9±3.5 12/18 NeerⅢ:11 NeerⅣ:16 28.2 ? ?
唐荐 2011[8] China CCS LP 52.5±6.9 24/39 NeerⅢ:38 NeerⅣ:25 24.5 NR 5
? ? ? HA 52.1±6.8 23/40 NeerⅢ:39 NeerⅣ:24 / ? ?
李乾 2011[9] China RCT LP ? 58/80 NeerⅢ:-NeerⅣ:- 6~24 NR 4
? ? ? HA ? / NeerⅢ:-NeerⅣ:- / ? ?
潘晓华 2011[10] China CCS LP 61.5 29/18 NeerⅢ:-NeerⅣ:- 14.5 NR 6
? ? ? HA ? / NeerⅢ:-NeerⅣ:- / ? ?
汤剑斌 2012[11] China CCS LP 66.23±12.21 7/13 NeerⅢ:14 NeerⅣ:6 20 NR 6
? ? ? HA 65.76±10.21 8/9 NeerⅣ:17 / ? ?
刘军 2012[12] China CCS LP 64.2±4.9 8/19 NeerⅢ:15 NeerⅣ:12 15.7 NR 7
? ? ? HA 70.1±5.5 2/8 NeerⅢ:5 NeerⅣ:6 / ? ?
付新生 2012[13] China CCS LP 62.31±5.4 7/11 NeerⅢ:10 NeerⅣ:8 18.5 NR 5
? ? ? HA 61.71±4.23 4/8 NeerⅢ:7 NeerⅣ:5 / ? ?
何帮剑 2013[14] China CCS LP 75.70±3.44 9/14 NeerⅢ:-NeerⅣ:- 24-72 NR 6
? ? ? HA 75.87±3.47 11/16 NeerⅢ:-NeerⅣ:- / ? ?
孔祥安 2014[15] China CCS LP 66.24±11.98 20/10 NeerⅢ:20 NeerⅣ:10 / NR 6
? ? ? HA 67.10±12.01 13/8 NeerⅣ:21 / ? ?
周鑫健 2014[16] China CCS LP 72.4±5.5 11/35 NeerⅢ:41 NeerⅣ:5 12.8 NR 6
? ? ? HA 73.2±6.2 7/28 NeerⅢ:10 NeerⅣ:25 12.4 ? ?
贺云飞 2014[17] China CCS LP 67 15/18 NeerⅢ:18 NeerⅣ:15 12-36 HA 6
? ? ? HA 69 16/19 NeerⅢ:16 NeerⅣ:19 12-36 ? ?
张敏 2015[18] China CCS LP 70.53±3.869 18/25 NeerⅢ:21 NeerⅣ:11 11.91 NR 6
? ? ? HA 70.18±4.644 ? NeerⅢ:4 NeerⅣ:7 10.82 ? ?
谢广东 2015[19] China RCT LP 69.3±8.7 14/20 NeerⅢ:23 NeerⅣ:11 / HA 5
? ? ? HA 68.9±7.6 13/21 NeerⅢ:24 NeerⅣ:10 / ? ?
邢金明 2015[20] China CCS LP 67.8±3.5 18/12 NeerⅢ:19 NeerⅣ:11 12~18 NR 7
? ? ? HA 69.2±3.8 10/7 NeerⅢ:10 NeerⅣ:7 / ? ?
王海洋 2015[21] China CCS LP 69.3±8.7 18/43 NeerⅢ:-NeerⅣ:- 15.5 NR 6
? ? ? HA ? / NeerⅢ:-NeerⅣ:- / ? ?
谢晓涛 2016[22] China CCS LP 70.3±7.7 13/16 NeerⅢ:18 NeerⅣ:11 51.6 NR 7
? ? ? HA 72.2±7.6 16/15 NeerⅢ:17 NeerⅣ:14 18.3 ? ?
杨杰 2015[23] China RCT LP 75.16±5.32 20/12 NeerⅢ:23 NeerⅣ:9 / HA 5*
? ? ? HA 74.36±6.27 21/11 NeerⅢ:25 NeerⅣ:7 / ? ?
Solberg 2009[24] USA CCS LP 66.5±8.6 12/26 NeerⅢ:23 NeerⅣ:15 36.1 LP 7
? ? ? HA 67.4±6.3 14/34 NeerⅢ:25 NeerⅣ:23 35.3 ? ?
Wild 2011[25] USA CCS LP 56.9±13 14/28 NeerⅢ:-NeerⅣ:- 35.6 LP 6
? ? ? HA 66.48±13.4 1/14 NeerⅢ:-NeerⅣ:- 34.7 ? ?
Cai 2012[26] China RCT LP 72.4 2/11 NeerⅣ:13 / HA 6*
? ? ? HA 71.1 3/16 NeerⅣ:19 / ? ?
Khurana 2016[27] USA CCS LP 63 17/48 NeerⅢ:-NeerⅣ:- / NR 7
? ? ? HA 68 8/19 NeerⅢ:-NeerⅣ:- / ? ?
Spross 2012[28] USA CCS LP 75 4/18 NeerⅣ:22 / HA 8
? ? ? HA 76 3/19 NeerⅣ:22 / ? ?
WP MultinationalA RomanGApelik 2016[29] TUR CCS LP 45.02±16.30 21/14 NeerⅢ:25 NeerⅣ:10 46.50 LP 6
? ? ? HA 60.26±13.86 18/5 NeerⅢ:13 NeerⅣ:10 48.0 ? ?
Bastian 2009[30] CHE Pros LP 54 / NeerⅡ:6 NeerⅢ:29 NeerⅣ:16 5 NR 8
? ? ? HA 66 / NeerⅢ:19 NeerⅣ:30 5 ? ?
Dietrich 2008[31] GER CCS LP 82 10/42 NeerⅢ:11 NeerⅣ:41 / LP 7
? ? ? HA 80 7/52 NeerⅢ:19 NeerⅣ:40 / ? ?
Thorsness 2014[32] USA CCS LP 64.2 105/225 NeerⅢ:-NeerⅣ:- / NR 7
? ? ? HA 69.3 17/66 NeerⅢ:-NeerⅣ:- / ? ?
图1 文献筛选流程图
图2 锁定钢板与半肩关节置换术后并发症森林图
图3 锁定钢板与半肩关节置换术后肩关节僵硬森林图
图4 锁定钢板与半肩关节置换术后肩关节不稳森林图
图5 锁定钢板与半肩关节置换术后肩峰下撞击症森林图
图6 锁定钢板与半肩关节置换术后并发症的亚组分析森林图
表2 锁定钢板与半肩关节置换术后肩关节功能评分Meta分析结果
图7 锁定钢板与半肩关节置换术后并发症发生数的漏斗图
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