Trauma Orthopedics and Hand Foot Ankle Surgery, The Ninth People's Hospital of Chongqing, Chongqing, 400700, China.
Department of Endocrinology, The Ninth People's Hospital of Chongqing, Chongqing, 400700, China.
BMC Musculoskelet Disord. 2023 Jul 17;24(1):583. doi: 10.1186/s12891-023-06626-0.
Humeral shaft fractures (HSFs) can be treated non-operatively (Non-OP), with open reduction and plate osteosynthesis (ORPO), minimally invasive plate osteosynthesis (MIPO), or with intramedullary nails (IMN). However, the best treatment for HSFs still remains controversial.We performed a network meta-analysis to explore which should be the best method for HSFs.
The computerized search had been conducted on electronic databases PubMed, EMBASE, Cochrane Library, and Medline from the establishment of the database to the end of December 2022. The quality evaluation of the included literature had been completed by Review Manager (version 5.4.1). Stata 17.0 software (Stata Corporation, College Station, Texas, USA)was used for network meta-analysis.We included randomized controlled trials (RCTs) comparing different treatments to treating HSFs.
The pairwise comparison results demonstrated that there was no statistical difference between IMN, MIPO, Non-OP, and ORPO in terms of radial nerve injury and infection, and Non-OP presented significantly more nonunion than ORPO, IMN, and MIPO. However, no statistically significant difference between ORPO, IMN, and MIPO was discovered. The results of the network meta-analysis displayed that surface under the cumulative ranking curve (SUCRA) probabilities of IMN, MIPO, Non-OP, and ORPO in radial nerve injury were 46.5%, 66.9%, 77.3%, and 9.3%, respectively, in contrast, that in infection were 68.6%, 53.3%, 62.4%, and 15.4%, respectively, and that in nonunion were 51.7%, 93.1%, 0.7%, and 54.5%, respectively.
We came to the conclusion that MIPO is currently the most effective way to treat HSFs.
Name of the registry: Prospero, 2. Unique Identifying number or registration ID: CRD42023411293.
肱骨干骨折（HSF）可通过非手术（Non-OP）、切开复位钢板内固定（ORPO）、微创钢板内固定（MIPO）或髓内钉（IMN）进行治疗。然而，HSF 的最佳治疗方法仍存在争议。我们进行了一项网络荟萃分析，以探讨哪种方法最适合治疗 HSF。
计算机检索电子数据库 PubMed、EMBASE、Cochrane 图书馆和 Medline，从数据库建立到 2022 年 12 月底。采用 Review Manager（版本 5.4.1）对纳入文献的质量进行评价。Stata 17.0 软件（Stata Corporation，德克萨斯州学院站，美国）用于网络荟萃分析。我们纳入了比较不同治疗方法治疗 HSF 的随机对照试验（RCT）。
成对比较结果表明，在桡神经损伤和感染方面，IMN、MIPO、Non-OP 和 ORPO 之间无统计学差异，Non-OP 与 ORPO、IMN 和 MIPO 相比，非愈合率显著更高。然而，在 ORPO、IMN 和 MIPO 之间没有发现统计学上的显著差异。网络荟萃分析结果显示，在桡神经损伤方面，IMN、MIPO、Non-OP 和 ORPO 的累积排序曲线下面积（SUCRA）概率分别为 46.5%、66.9%、77.3%和 9.3%，而在感染方面分别为 68.6%、53.3%、62.4%和 15.4%，在非愈合方面分别为 51.7%、93.1%、0.7%和 54.5%。
我们得出结论，MIPO 是目前治疗 HSF 的最有效方法。
注册名称：Prospéro，2. 独特识别编号或注册 ID：CRD42023411293。
