Chen Bing-Kuan, Tai Ting-Han, Lin Shu-Hsuan, Chen Kuan-Hao, Huang Yu-Min, Chen Chih-Yu
School of Medicine, College of Medicine, Taipei Medical University, Taipei 11031, Taiwan.
Division of General Medicine, Department of Medical Education, Shuang Ho Hospital, Taipei Medical University, New Taipei City 23561, Taiwan.
J Clin Med. 2024 Jan 28;13(3):755. doi: 10.3390/jcm13030755.
(1) Pathological humeral shaft fracture (PHSF) is a frequently observed clinical manifestation in the later stages of tumor metastasis. Surgical interventions are typically recommended to alleviate pain and restore functionality. Intramedullary nail fixation (INF) or plate fixation (PF) is currently recommended for the treatment of PHSF. However, there is still no standard for optimal surgical treatment. Thus, we conducted a meta-analysis comparing the clinical outcomes of INF with PF for PHSF treatment. (2) We conducted searches in databases, such as Scopus, EMBASE, and PubMed, for studies published prior to May 2023. In total, nine studies with 485 patients were reviewed. (3) There were no significant differences noted in the incidence of fixation failure, local recurrence, wound complication or overall complication. However, the INF group demonstrated a significantly lower incidence of postoperative radial nerve palsy than the PF group (OR, 5.246; 95% CI, 1.548-17.774; = 0.008). A subgroup analysis indicated that there were no statistically significant differences in fixation failure or local recurrence among subgroups categorized by the design of intramedullary nail. (4) Considering the short life expectancy of end-stage patients, the choice of surgical method depends on the patient's individual condition, fracture and lesion patterns, the surgeon's experience, and comprehensive discussion between the surgeon and patient.
(1) 病理性肱骨干骨折（PHSF）是肿瘤转移后期常见的临床表现。通常建议采取手术干预以减轻疼痛并恢复功能。目前推荐采用髓内钉固定（INF）或钢板固定（PF）治疗PHSF。然而，对于最佳手术治疗仍没有标准。因此，我们进行了一项荟萃分析，比较INF与PF治疗PHSF的临床结果。(2) 我们在Scopus、EMBASE和PubMed等数据库中检索了2023年5月之前发表的研究。总共审查了9项研究，涉及485例患者。(3) 在固定失败、局部复发、伤口并发症或总体并发症的发生率方面未发现显著差异。然而，INF组术后桡神经麻痹的发生率明显低于PF组（OR，5.246；95%CI，1.548 - 17.774；P = 0.008）。亚组分析表明，按髓内钉设计分类的亚组之间在固定失败或局部复发方面没有统计学上的显著差异。(4) 考虑到终末期患者预期寿命较短，手术方法的选择取决于患者的个体情况、骨折和病变模式、外科医生的经验以及外科医生与患者之间的全面讨论。
