Department of Orthopaedic Surgery and Traumatology, Kolding Hospital-Part of Hospital Lillebaelt, Kolding, Denmark.
Department of Orthopaedic Surgery and Traumatology, Kolding Hospital-Part of Hospital Lillebaelt, Kolding, Denmark.
J Shoulder Elbow Surg. 2020 Dec;29(12):2495-2504. doi: 10.1016/j.jse.2020.05.030. Epub 2020 Jun 15.
The humeral shaft fracture accounts for 1%-3% of all fractures and occurs in both the young and old population. However, the optimal treatment is still a matter of debate. Even though nonoperative treatment is commonly considered the gold standard, advantages have been described using operative stabilization. This systematic review aims to compare operative and nonoperative treatment in adult patients with humeral shaft fractures.
We used the following databases: PubMed, Embase, Cochrane, and CINAHL on October 1, 2018, searching for randomized controlled trials (RCTs) and cohort studies. Two reviewers screened the studies using Covidence, followed by systematic data extraction. The primary outcome was defined as posttreatment complications such as nonunion, radial nerve palsy, malunion, and infections. The secondary outcomes were functional scores and patient-reported outcome measures (PROMs). To assess study quality, the risk of bias in nonrandomized studies of interventions and the Cochrane risk of bias tool were used.
Twelve studies were included: 1 RCT, 1 prospective cohort, and 10 retrospective cohorts with a total of 1406 patients, of whom 835 were treated operatively and 571 nonoperatively. Mean age ranged from 35 to 64, and 54% of the patients were male. The cohort studies had, in general, moderate bias, whereas the RCT had a low bias. There were statistically significant fewer nonunions in the operative treated group with a risk ratio of 0.49 (0.35-0.67), yielding a number needed to treat = 12. There were more deep infections in the operative group with a risk ratio of 2.76 (1.01-7.53) but otherwise no statistical differences concerning malunion or nerve damage. Only 1 study included PROM data.
There were fewer nonunions in the operative group but more deep infections. Because of the lack of studies reporting PROMs, the potential positive effect of operative therapy in early aftercare could not be evaluated. Therefore, PROMs should be mandatory in future comparative studies.
肱骨干骨折占所有骨折的 1%-3%，可发生于年轻人群和老年人群。然而，最佳治疗方法仍存在争议。尽管非手术治疗通常被认为是金标准，但手术固定也具有优势。本系统评价旨在比较肱骨干骨折成年患者的手术治疗与非手术治疗。
我们使用了以下数据库：2018 年 10 月 1 日的 PubMed、Embase、Cochrane 和 CINAHL，检索随机对照试验（RCT）和队列研究。两名评审员使用 Covidence 筛选研究，然后进行系统数据提取。主要结局定义为治疗后并发症，如骨不连、桡神经麻痹、畸形愈合和感染。次要结局为功能评分和患者报告的结局测量（PROM）。为评估研究质量，使用了非随机干预研究的干预措施偏倚风险和 Cochrane 偏倚风险工具。
共纳入 12 项研究：1 项 RCT、1 项前瞻性队列研究和 10 项回顾性队列研究，共纳入 1406 例患者，其中 835 例接受手术治疗，571 例接受非手术治疗。平均年龄为 35-64 岁，54%的患者为男性。队列研究总体偏倚程度为中度，而 RCT 的偏倚程度为低度。手术治疗组的骨不连发生率明显较低，风险比为 0.49（0.35-0.67），需要治疗的人数为 12。手术组深部感染发生率较高，风险比为 2.76（1.01-7.53），但在畸形愈合或神经损伤方面无统计学差异。仅有 1 项研究报告了 PROM 数据。
手术组的骨不连发生率较低，但深部感染发生率较高。由于缺乏报告 PROM 的研究，无法评估手术治疗在早期康复中的潜在积极作用。因此，在未来的比较研究中，PROM 应该是强制性的。
