Department of Orthopedic and Trauma Surgery, Lucerne Cantonal Hospital, Lucerne, Switzerland.
Faculty of Health Sciences and Medicine, University of Lucerne, Lucerne, Switzerland.
Eur J Trauma Emerg Surg. 2024 Oct;50(5):2053-2060. doi: 10.1007/s00068-024-02520-z. Epub 2024 Apr 8.
It is unclear if elderly patients treated with plate osteosynthesis for proximal humerus fractures benefit from cement augmentation. This meta-analysis aims to compare cement augmentation to no augmentation regarding healing, complications, and functional results.
PubMed, Embase, and Cochrane Central Register of Controlled Trials were searched for randomized clinical trials and observational studies. Effect estimates were pooled across studies using random effects models. The primary outcome is overall complication rate. Stratified analyses were performed for types of complication (implant-related or systemic). Secondary outcomes include re-interventions, hospital stay, operation time, functional scores, and general quality of life.
Five observational studies and one randomized controlled trial with a total of 541 patients were included. The overall complication rate was significantly lower in the augmented group (15.6% versus 25.4%, OR 0.54 (95%CI 0.33-0.87)). This was caused by a reduction of implant-related complications (10.4% vs. 19.9%, OR 0.49 (95%CI 0.28, 0.88)). No difference in humeral head necrosis was found. Data on re-intervention, hospital stay, and operation time was limited but did not show significant differences. No impact on functional scores and general quality of life was detected.
This meta-analysis shows that cement augmentation may reduce overall complications, mainly by preventing implant-related complications. No difference was detected regarding need for re-intervention, functional scores, general quality of life, and hospital stay. This is the first meta-analysis on this topic. It remains to be seen whether conclusions will hold when more and better-quality data becomes available.
目前尚不清楚接受钢板内固定治疗肱骨近端骨折的老年患者是否受益于骨水泥强化。本荟萃分析旨在比较骨水泥强化与不强化在愈合、并发症和功能结果方面的差异。
通过 PubMed、Embase 和 Cochrane 对照试验中心注册库检索随机临床试验和观察性研究。使用随机效应模型对研究间的效应估计值进行汇总。主要结局是总体并发症发生率。对并发症类型（与植入物相关或全身性）进行分层分析。次要结局包括再次干预、住院时间、手术时间、功能评分和一般生活质量。
纳入了 5 项观察性研究和 1 项随机对照试验，共 541 名患者。强化组的总体并发症发生率显著降低（15.6%与 25.4%，OR 0.54（95%CI 0.33-0.87））。这是由于与植入物相关的并发症减少（10.4%与 19.9%，OR 0.49（95%CI 0.28，0.88））。未发现肱骨头坏死的差异。再次干预、住院时间和手术时间的数据有限，但没有发现显著差异。功能评分和一般生活质量没有受到影响。
本荟萃分析表明，骨水泥强化可能降低总体并发症，主要是通过预防与植入物相关的并发症。在需要再次干预、功能评分、一般生活质量和住院时间方面，未发现差异。这是该主题的第一项荟萃分析。当更多且高质量的数据可用时，结论是否成立仍有待观察。
