Zhao Jia-Guo, Wang Jia, Meng Xiao-Hui, Zeng Xian-Tie, Kan Shi-Lian
Departments of Orthopaedic Surgery, Clinical College of Orthopaedic Surgery, Tianjin Medical University, Tianjin, China.
Department of Orthopaedic Surgery, Tianjin Hospital, Tianjin, China.
PLoS One. 2017 Mar 23;12(3):e0173634. doi: 10.1371/journal.pone.0173634. eCollection 2017.
There are three main surgical techniques to treat humeral shaft fractures: open reduction and plate fixation (ORPF), intramedullary nail (IMN) fixation, and minimally invasive percutaneous osteosynthesis (MIPO). We performed a network meta-analysis to compare three surgical procedures, including ORPF, IMN fixation, and MIPO, to provide the optimum treatment for humerus shaft fractures.
MEDLINE, EMBASE, Cochrane Bone, Joint and Muscle Trauma Group Specialised Register, and Cochrane library were researched for reports published up to May 2016. We only included randomized controlled trials (RCTs) comparing two or more of the three surgical procedures, including the ORPF, IMN, and MIPO techniques, for humeral shaft fractures in adults. The methodological quality was evaluated based on the Cochrane risk of bias tool. We used WinBUGS1.4 to conduct this Bayesian network meta-analysis. We used the odd ratios (ORs) with 95% confidence intervals (CIs) to calculate the dichotomous outcomes and analyzed the percentages of the surface under the cumulative ranking curve.
Seventeen eligible publications reporting 16 RCTs were included in this study. Eight hundred and thirty-two participants were randomized to receive one of three surgical procedures. The results showed that shoulder impingement occurred more commonly in the IMN group than with either ORPF (OR, 0.13; 95% CI, 0.03-0.37) or MIPO fixation (OR, 0.08; 95% CI, 0.00-0.69). Iatrogenic radial nerve injury occurred more commonly in the ORPF group than in the MIPO group (OR, 11.09; 95% CI, 1.80-124.20). There were no significant differences among the three procedures in nonunion, delayed union, and infection.
Compared with IMN and ORPF, MIPO technique is the preferred treatment method for humeral shaft fractures.
治疗肱骨干骨折主要有三种手术技术：切开复位钢板内固定术（ORPF）、髓内钉（IMN）固定术和微创经皮钢板接骨术（MIPO）。我们进行了一项网状Meta分析，比较ORPF、IMN固定术和MIPO这三种手术方法，以提供肱骨干骨折的最佳治疗方案。
检索MEDLINE、EMBASE、Cochrane骨、关节和肌肉创伤组专业注册库以及Cochrane图书馆，查找截至2016年5月发表的报告。我们仅纳入比较三种手术方法中的两种或更多种（包括ORPF、IMN和MIPO技术）治疗成人肱骨干骨折的随机对照试验（RCT）。根据Cochrane偏倚风险工具评估方法学质量。我们使用WinBUGS1.4进行这项贝叶斯网状Meta分析。我们使用具有95%置信区间（CI）的比值比（OR）来计算二分结果，并分析累积排名曲线下面积的百分比。
本研究纳入了17篇符合条件的出版物，报告了16项RCT。832名参与者被随机分配接受三种手术方法中的一种。结果显示，IMN组肩峰撞击的发生率高于ORPF组（OR，0.13；95%CI，0.03 - 0.37）或MIPO固定组（OR，0.08；95%CI，0.00 - 0.69）。ORPF组医源性桡神经损伤的发生率高于MIPO组（OR，11.09；95%CI，1.80 - 124.20）。三种手术方法在骨不连、延迟愈合和感染方面无显著差异。
与IMN和ORPF相比，MIPO技术是肱骨干骨折的首选治疗方法。
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