Launonen Antti P, Lepola Vesa, Flinkkilä Tapio, Laitinen Minna, Paavola Mika, Malmivaara Antti
Department of Orthopaedics , Tampere University Hospital , Tampere.
Acta Orthop. 2015 Jun;86(3):280-5. doi: 10.3109/17453674.2014.999299. Epub 2015 Jan 9.
There is no consensus on the treatment of proximal humerus fractures in the elderly.
We conducted a systematic search of the medical literature for randomized controlled trials and controlled clinical trials from 1946 to Apr 30, 2014. Predefined PICOS criteria were used to search relevant publications. We included randomized controlled trials involving 2- to 4-part proximal humerus fractures in patients over 60 years of age that compared operative treatment to any operative or nonoperative treatment, with a minimum of 20 patients in each group and a minimum follow-up of 1 year. Outcomes had to be assessed with functional or disability measures, or a quality-of-life score.
After 2 independent researchers had read 777 abstracts, 9 publications with 409 patients were accepted for the final analysis. No statistically significant differences were found between nonoperative treatment and operative treatment with a locking plate for any disability, for quality-of-life score, or for pain, in patients with 3- or 4-part fractures. In 4-part fractures, 2 trials found similar shoulder function between hemiarthroplasty and nonoperative treatment. 1 trial found slightly better health-related quality of life (higher EQ-5D scores) at 2-year follow-up after hemiarthroplasty. Complications were common in the operative treatment groups (10-29%).
Nonoperative treatment over locking plate systems and tension banding is weakly supported. 2 trials provided weak to moderate evidence that for 4-part fractures, shoulder function is not better with hemiarthroplasty than with nonoperative treatment. 1 of the trials provided limited evidence that health-related quality of life may be better at 2-year follow-up after hemiarthroplasty. There is a high risk of complications after operative treatment.
对于老年肱骨近端骨折的治疗尚无共识。
我们对1946年至2014年4月30日期间的医学文献进行了系统检索，以查找随机对照试验和对照临床试验。使用预定义的PICOS标准搜索相关出版物。我们纳入了涉及60岁以上患者的2至4部分肱骨近端骨折的随机对照试验，这些试验将手术治疗与任何手术或非手术治疗进行比较，每组至少20例患者，且最短随访时间为1年。结局必须通过功能或残疾测量或生活质量评分进行评估。
在两名独立研究人员阅读了777篇摘要后，9篇包含409例患者的出版物被纳入最终分析。对于3部分或4部分骨折的患者，在任何残疾、生活质量评分或疼痛方面，非手术治疗与锁定钢板手术治疗之间未发现统计学上的显著差异。在4部分骨折中，2项试验发现半关节置换术与非手术治疗之间的肩部功能相似。1项试验发现，半关节置换术后2年随访时，与健康相关的生活质量略好（EQ-5D评分更高）。手术治疗组并发症常见（10%-29%）。
非手术治疗优于锁定钢板系统和张力带固定的证据不足。2项试验提供了弱至中等强度的证据，表明对于4部分骨折，半关节置换术的肩部功能并不优于非手术治疗。其中1项试验提供了有限的证据，表明半关节置换术后2年随访时与健康相关的生活质量可能更好。手术治疗后并发症风险高。
