Xu Jiaming, Zhang Changqing, Wang Tao
Department of Orthopedics, Shanghai Jiaotong University Affiliated Sixth People's Hospital, 600 Yishan Road, Shanghai 200233, China.
J Orthop Surg Res. 2014 Apr 27;9:31. doi: 10.1186/1749-799X-9-31.
Proximal humeral fractures are common lesions of the elderly, but there are no established treatment guidelines. A surgical treatment for comminuted and displaced fractures of the proximal humerus was developed and is still evolving. The aim of this study was to perform a quantitative review to evaluate the risk of avascular necrosis (AVN) in patients with proximal humeral fractures who were treated by operative fixation compared with conservative treatment.
We searched the PubMed, MEDLINE, Springer, Elsevier Science Direct, Cochrane Library, Google Scholar, China National Knowledge Infrastructure (in Chinese), and Wanfang database (in Chinese) up to December 2013 to identify studies related to operative fixation and AVN in patients with proximal humeral fractures.
Seven studies with a total of 291 patients (142 operative fixation cases and 149 conservative treatment cases) with proximal humeral fractures were considered in the meta-analysis. The overall meta-analysis showed no significant difference in the incidence of AVN between the two groups [odds ratio (OR) 1.42, 95% confidence interval (CI) 0.33-6.11, p = 0.64]. The subgroup meta-analysis by study design (retrospective/prospective), sample size (≤40/>40), and ethnicity (European/Asian) demonstrated similar results. However, the subgroup analysis by specific operative approach (plate fixation/tension band wiring fixation/others) indicated that plate fixation was associated with a higher rate of AVN than conservative treatment (OR 0.20, 95% CI 0.05-0.76, p = 0.019).
Plate fixation was associated with a higher risk of AVN development than conservative treatment in patients with proximal humeral fractures.
肱骨近端骨折是老年人的常见损伤，但目前尚无既定的治疗指南。一种针对肱骨近端粉碎性和移位骨折的手术治疗方法已被开发出来，并且仍在不断发展。本研究的目的是进行一项定量综述，以评估与保守治疗相比，接受手术固定治疗的肱骨近端骨折患者发生缺血性坏死（AVN）的风险。
我们检索了截至2013年12月的PubMed、MEDLINE、Springer、Elsevier Science Direct、Cochrane图书馆、谷歌学术、中国知网（中文）和万方数据库（中文），以确定与肱骨近端骨折患者手术固定和AVN相关的研究。
荟萃分析纳入了7项研究，共291例肱骨近端骨折患者（142例手术固定病例和149例保守治疗病例）。总体荟萃分析显示，两组之间AVN的发生率无显著差异[比值比（OR）1.42，95%置信区间（CI）0.33 - 6.11，p = 0.64]。按研究设计（回顾性/前瞻性）、样本量（≤40/>40）和种族（欧洲人/亚洲人）进行的亚组荟萃分析显示了相似的结果。然而，按具体手术方式（钢板固定/张力带钢丝固定/其他）进行的亚组分析表明，钢板固定与保守治疗相比，AVN发生率更高（OR 0.20，95% CI 0.05 - 0.76，p = 0.019）。
在肱骨近端骨折患者中，钢板固定比保守治疗发生AVN的风险更高。
