Department of Orthopaedics and Traumatology, Nanfang Hospital, Southern Medical University, Guangzhou, China.
J Shoulder Elbow Surg. 2013 Mar;22(3):387-95. doi: 10.1016/j.jse.2012.06.007. Epub 2012 Sep 1.
Regarding the treatment of humeral shaft fractures, the choice of plating or intramedullary nailing remains controversial. Previous randomized controlled trials and meta-analyses failed to draw a unanimous conclusion. To guide clinical decision making, we conducted an updated meta-analysis on the optimal treatment of humeral shaft fractures.
We identified eligible studies published from 1969 to July 2011 using the Cochrane Library; Cochrane Bone, Joint and Muscle Trauma Group; MEDLINE; Embase; OVID; and Google Scholar and manually searched the references of relevant studies. Randomized controlled trials that compared nailing and plating in the treatment of humeral shaft fractures were included. After the methodologic assessment, available data were extracted and statistically reviewed. The primary outcomes were nonunion, delayed union, postoperative infection, reoperation, and radial nerve palsy. The secondary outcomes were restriction of shoulder motion, shoulder impingement, iatrogenic fracture comminution, and implant failure.
We included 10 studies comparing plating and nailing in patients with humeral shaft fractures, comprising 439 participants. Plating reduced the risk of shoulder impingement and shoulder restriction in comparison with nailing. Regarding reoperation risk, a secondary sensitivity analysis showed the finding favoring plating over nailing remained unstable. Otherwise, no significant differences were found in postoperative infection, nonunion, delayed union, radial nerve palsy, iatrogenic fracture comminution, and implant failure between groups.
On the basis of current evidence, both plating and nailing can achieve a similar treatment effect on humeral shaft fractures, but plating may reduce the occurrence of shoulder problems. Randomized controlled trials with larger sample sizes using appropriate blinding methods are needed to confirm these findings.
Level II, Meta-analysis of prospective comparative trials.
对于肱骨干骨折的治疗,钢板固定与髓内钉固定的选择仍存在争议。既往的随机对照试验和荟萃分析未能得出一致的结论。为了指导临床决策,我们对肱骨干骨折的最佳治疗方法进行了更新的荟萃分析。
我们使用 Cochrane 图书馆、Cochrane 骨骼、关节和肌肉创伤组、MEDLINE、Embase、OVID、Google Scholar 检索 1969 年至 2011 年 7 月发表的合格研究,并手动检索相关研究的参考文献。纳入比较钢板固定与髓内钉治疗肱骨干骨折的随机对照试验。方法学评估后,提取并进行统计学分析。主要结局指标为骨折不愈合、延迟愈合、术后感染、再次手术和桡神经麻痹。次要结局指标为肩关节活动受限、肩关节撞击、医源性骨折粉碎和植入物失败。
我们纳入了 10 项比较钢板固定与髓内钉治疗肱骨干骨折的研究,共 439 名患者。与髓内钉相比,钢板固定降低了肩关节撞击和肩关节活动受限的风险。关于再次手术的风险,二次敏感性分析显示,钢板固定的优势仍不稳定。此外,两组间术后感染、骨折不愈合、延迟愈合、桡神经麻痹、医源性骨折粉碎和植入物失败发生率无显著差异。
基于现有证据,钢板固定和髓内钉固定均可获得相似的肱骨干骨折治疗效果,但钢板固定可能减少肩关节问题的发生。需要更大样本量、采用合适盲法的随机对照试验来证实这些发现。
Ⅱ级,前瞻性对照试验的荟萃分析。