三种不同手术方法治疗肱骨干骨折的贝叶斯网络Meta分析
A Bayesian network meta-analysis of three different surgical procedures for the treatment of humeral shaft fractures.
作者信息
Qiu Hao, Wei Zhihui, Liu Yuting, Dong Jing, Zhou Xin, Yin Liangjun, Zhang Minhua, Lu Minpeng
机构信息
Department of Orthopaedic Surgery, Yongchuan Hospital of Chongqing Medical University Department of Orthopaedic Surgery, The Children's Hospital of Chongqing Medical University Department of Endocrinology, The Second Affiliated Hospital of Chongqing Medical University Department of Endocrinology, Yongchuan Hospital of Chongqing Medical University Department of Orthopaedic Surgery, The Second Affiliated Hospital of Chongqing Medical University, Chongqing, China.
出版信息
Medicine (Baltimore). 2016 Dec;95(51):e5464. doi: 10.1097/MD.0000000000005464.
BACKGROUND
The optimal surgical procedure for humeral shaft fractures remains a matter of debate. We aimed to establish the optimum procedure by performing a Bayesian network meta-analysis.
METHODS
PubMed, EMBASE, the Cochrane Library, and Medline were searched for both randomized controlled trials and prospective studies of surgical treatment for humeral shaft fractures. The quality of the included studies was assessed according to the Cochrane Collaboration's "Risk of bias".
RESULTS
Seventeen RCTs or prospective studies were included in the meta-analysis. The pooled results showed that the occurrence rate of radial nerve injury was lowest for minimally invasive plate osteosynthesis (MIPO; SUCRA probability, 95.1%), followed by open reduction and plate osteosynthesis (ORPO; SUCRA probability, 29.5%), and was highest for intramedullary nailing (IMN; SUCRA probability, 25.4%). The aggregated results of pairwise meta-analysis showed no significant difference in radial nerve injury rate when comparing ORPO versus IMN (OR, 1.92; 95% CI, 0.96 to 3.86), ORPO versus MIPO (OR, 3.38; 95% CI, 0.80 to 14.31), or IMN versus MIPO (OR, 3.19; 95% CI, 0.48 to 21.28). Regarding the nonunion, SUCRA probabilities were 90.5%, 40.2%, and 19.3% for MIPO, ORPO, and IMN, respectively. The aggregated results of a pairwise meta-analysis also showed no significant difference for ORPO versus IMN (OR, 0.83; 95% CI, 0.41 to 1.69), ORPO versus MIPO (OR, 2.42; 95% CI, 0.45 to 12.95), or IMN versus MIPO (OR, 2.49; 95% CI, 0.35 to 17.64).
CONCLUSION
The current evidence indicates that MIPO is the optimum choice in the treatment of humeral shaft fractures and that ORPO is superior to IMN.
背景
肱骨干骨折的最佳手术方法仍存在争议。我们旨在通过进行贝叶斯网络荟萃分析来确定最佳手术方法。
方法
检索了PubMed、EMBASE、Cochrane图书馆和Medline，以查找关于肱骨干骨折手术治疗的随机对照试验和前瞻性研究。根据Cochrane协作网的“偏倚风险”评估纳入研究的质量。
结果
荟萃分析纳入了17项随机对照试验或前瞻性研究。汇总结果显示，微创钢板接骨术（MIPO；累积排序曲线下面积概率，95.1%）导致桡神经损伤的发生率最低，其次是切开复位钢板接骨术（ORPO；累积排序曲线下面积概率，29.5%），而髓内钉固定术（IMN；累积排序曲线下面积概率，25.4%）导致桡神经损伤的发生率最高。成对荟萃分析的汇总结果显示，比较ORPO与IMN时，桡神经损伤率无显著差异（比值比，1.92；95%置信区间，0.96至3.86），比较ORPO与MIPO时无显著差异（比值比，3.38；95%置信区间，0.80至14.31），比较IMN与MIPO时也无显著差异（比值比，3.19；95%置信区间，0.48至21.28）。关于骨不连，MIPO、ORPO和IMN的累积排序曲线下面积概率分别为90.5%、40.2%和19.3%。成对荟萃分析的汇总结果还显示，比较ORPO与IMN时无显著差异（比值比，0.83；置信区间，0.41至1.69），比较ORPO与MIPO时无显著差异（比值比，2.42；95%置信区间，0.45至12.95），比较IMN与MIPO时也无显著差异（比值比，2.49；95%置信区间，0.35至17.64）。
结论
目前的证据表明，MIPO是治疗肱骨干骨折的最佳选择，且ORPO优于IMN。
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