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[1]李亞楠,張起,古恩鵬.手術(shù)與非手術(shù)治療肱骨近端骨折的Meta分析[J].中醫(yī)正骨,2018,30(09):42-48.
　LI Yanan,ZHANG Qi,GU Enpeng.Comparison of operative treatment and non-operative treatment for treatment of proximal humeral fractures:a meta analysis[J].The Journal of Traditional Chinese Orthopedics and Traumatology,2018,30(09):42-48.
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手術(shù)與非手術(shù)治療肱骨近端骨折的Meta分析()
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《中醫(yī)正骨》[ISSN:1001-6015/CN:41-1162/R]

卷:
第30卷
期數(shù):
2018年09期
頁碼:
42-48
欄目:
文獻(xiàn)研究
出版日期:
2018-09-20

文章信息/Info

Title:
Comparison of operative treatment and non-operative treatment for treatment of proximal humeral fractures:a meta analysis
作者:
李亞楠1; 張起2; 古恩鵬2
1.天津中醫(yī)藥大學(xué),天津 300380; 2.天津市濱海新區(qū)中醫(yī)醫(yī)院,天津 300450
Author(s):
LI Yanan1; ZHANG Qi2; GU Enpeng2
1.Tianjin University of Traditional Chinese Medicine,Tianjin 300380,China 2.Tianjin Binhai New District Hospital of Traditional Chinese Medicine,Tianjin 300450,China
關(guān)鍵詞:
肩骨折;  肱骨骨折;  手術(shù);  非手術(shù)治療;  隨機(jī)對(duì)照試驗(yàn);  Meta分析;  系統(tǒng)評(píng)價(jià)
Keywords:
shoulder fractures;  humeral fractures;  operative treatment;  non-operative treatment;  randomized controlled trial;  Meta-analysis;  systematic review
摘要:
比較手術(shù)與非手術(shù)治療肱骨近端骨折的臨床療效和安全性。方法:應(yīng)用計(jì)算機(jī)檢索CNKI、萬方、維普、PubMed、Embase、Cochrance Lirbary建庫(kù)至2018年4月國(guó)內(nèi)外公開發(fā)表的手術(shù)與非手術(shù)治療肱骨近端骨折的隨機(jī)對(duì)照研究文獻(xiàn)。由2位研究者嚴(yán)格按照納入與排除標(biāo)準(zhǔn)獨(dú)立篩選文獻(xiàn)并提取資料,采用Cochrane風(fēng)險(xiǎn)偏倚評(píng)估工具進(jìn)行文獻(xiàn)方法學(xué)質(zhì)量評(píng)價(jià)后,采用Review 5.3軟件進(jìn)行Meta分析。結(jié)果:最初檢索出1212篇相關(guān)文獻(xiàn),通過詳細(xì)閱讀文章標(biāo)題、摘要及全文,最終納入9篇文獻(xiàn),均為英文文獻(xiàn)。納入研究的對(duì)象共585例,手術(shù)組288例、非手術(shù)組297例。Meta分析結(jié)果顯示,2組Constant-Murley肩關(guān)節(jié)評(píng)分、遠(yuǎn)期肌肉力量評(píng)分、歐洲五維健康量表評(píng)分、肱骨頭缺血性壞死發(fā)生率、骨折不愈合率、骨關(guān)節(jié)炎發(fā)生率、再手術(shù)率、神經(jīng)損傷發(fā)生率、死亡率比較,組間差異均無統(tǒng)計(jì)學(xué)意義[WMD=-0.90,95%CI(-4.18,2.37); WMD=-1.14,95%CI(-2.83,0.54); WMD=0.02,95%CI(-0.02,0.06); RR=0.92,95%CI(0.58,1.48); RR=0.59,95%CI(0.24,1.47); RR=0.59,95%CI(0.21,1.62); RR=2.04,95%CI(1.13,3.71); RR=1.26,95%CI(0.40,3.92); RR=1.58,95%CI(0.76,3.29)],手術(shù)組的遠(yuǎn)期疼痛評(píng)分低于非手術(shù)組[WMD=1.77,95%CI(0.72,2.81)]。結(jié)論:手術(shù)與非手術(shù)治療肱骨近端骨折,均能改善肩關(guān)節(jié)功能,提高患者生存質(zhì)量,二者的安全性相當(dāng),但手術(shù)治療在改善遠(yuǎn)期疼痛方面優(yōu)于非手術(shù)治療。
Abstract:
To compare the clinical curative effects and safety of operative treatment versus non-operative treatment for treatment of proximal humeral fractures.Methods:All the randomized controlled trial(RCT)articles about operative treatment(operative group)versus non-operative treatment(non-operative group)for treatment of proximal humeral fractures that published at home and abroad included from database establishing to April 2018 were retrieved from China national knowledge internet,WanFang Data,Vip Data,PubMed,Embase and Cochrance Lirbary through computer.The articles were screened and the information was extracted independently and strictly by two searchers according to the inclusion and exclusion criteria.The methodological quality of research in the articles was evaluated by using Cochrane risk bias assessment tools,and a Meta-analysis was conducted by using Review 5.3 software.Results:One thousand two hundred and twelve articles were searched out.After screening through reading titles,abstracts and full texts of the articles in detail,9 English articles(585 patients)were included in the final analysis,288 patients in operative group and 297 patients in non-operative group.The results of Meta-analysis demonstrated that there was no statistical difference in Constant-Murley shoulder scores,long-term muscle strength scores,European quality of life 5-dimensions(EQ-5D)scores and the incidence rate of ischemic necrosis of humeral head,fracture nonunion,osteoarthritis,reoperation,nerve injuries and death between the 2 groups(WMD=-0.90,95%CI(-4.18,2.37); WMD=-1.14,95%CI(-2.83,0.54); WMD=0.02,95%CI(-0.02,0.06); RR=0.92,95%CI(0.58,1.48); RR=0.59,95%CI(0.24,1.47); RR=0.59,95%CI(0.21,1.62); RR=2.04,95%CI(1.13,3.71); RR=1.26,95%CI(0.40,3.92); RR=1.58,95%CI(0.76,3.29)).The long-term pain scores were lower in operative group compared to non-operative group(WMD=1.77,95%CI(0.72,2.81)).Conclusion:Both operative treatment and non-operative treatment can effectively improve patient's shoulder function and life quality in treatment of proximal humeral fractures.They are similar to each other in safety,however,the former surpasses the latter in improving the long-term pain.

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備注/Memo

備注/Memo:
基金項(xiàng)目:天津市衛(wèi)生和計(jì)劃生育委員會(huì)中醫(yī)、中西醫(yī)結(jié)合科研課題(2017097) 通訊作者:古恩鵬 E-mail:[email protected]
更新日期/Last Update: 2018-09-20