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浙江大学学报（医学版）
浙江大学学报（医学版）  2016, Vol. 45 Issue (6): 641-647    DOI: 10.3785/j.issn.1008-9292.2016.11.14
meta分析     
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
李文波1, 丁高恒2, 刘军1, 石杰1, 张超1, 高秋明1
1. 兰州军区兰州总医院全军骨科中心创伤骨科, 甘肃 兰州 730050;
2. 甘肃中医药大学公共卫生学院, 甘肃 兰州 730000
Operative versus non-operative treatment for three- or four-part proximal humeral fractures in elderly patients: a meta-analysis of randomized controlled trials
LI Wenbo1, DING Gaoheng2, LIU Jun1, SHI Jie1, ZHANG Chao1, GAO Qiuming1
1. Orthopaedic Trauma of Orthopaedics Center, Lanzhou General Hospital of PLA, Lanzhou 730050, China;
2. School of Public Health, Gansu University of Traditional Chinese Medicine, Lanzhou 730000, China
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摘要：

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。
关键词： Meta分析;  肩骨折/外科学;  手法,骨科;  老年人;  骨折固定;  治疗结果    
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
收稿日期: 2016-08-08
CLC:  R683  
基金资助:

甘肃省自然科学基金（1506RJZA298）；甘肃省青年科技基金（1606RJYA300）
通讯作者: 高秋明(1970-),男,硕士,副主任医师,硕士生导师,主要从事创伤骨科及显微外科研究;E-mail:gaoqm001@sohu.com;http://orcid.org/0000-0003-2403-1082     E-mail: gaoqm001@sohu.com
作者简介: 李文波(1992-),男,硕士研究生,主要从事创伤骨病和骨髓炎诊治研究;E-mail:dliwenb@163.com;http://orcid.org/0000-0002-1812-9457
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引用本文:

李文波 等. 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[J]. 浙江大学学报（医学版）, 2016, 45(6): 641-647.

LI Wenbo, DING Gaoheng, LIU Jun, SHI Jie, ZHANG Chao, GAO Qiuming. Operative versus non-operative treatment for three- or four-part proximal humeral fractures in elderly patients: a meta-analysis of randomized controlled trials. Journal of ZheJiang University(Medical Science), 2016, 45(6): 641-647.

链接本文:

http://www.zjujournals.com/xueshu/med/CN/10.3785/j.issn.1008-9292.2016.11.14    或    http://www.zjujournals.com/xueshu/med/CN/Y2016/V45/I6/641

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