Sharma Tarun Kumar, Kumar Deepak, Gupta Aditya, Bachhal Vikas, Bansal Arjit, Bhayana Himanshu
Department of Biochemistry, Government Medical College and Hospital, Sector 32, Chandigarh, India.
Department of Orthopaedics, Post Graduate Institute of Medical Education and Research, Sector 12, Chandigarh, India.
J Orthop. 2024 Jul 18;58:140-145. doi: 10.1016/j.jor.2024.07.005. eCollection 2024 Dec.
There is no standard protocol for managing non-union of diaphyseal humerus bone, with several authors reporting their results using various techniques and methods for its management. No meta-analysis has reported the results of managing these cases with non-vascularized fibula grafting as an adjuvant for osteosynthesis.
This meta-analysis was performed to estimate the pooled data for calculating the union rates in diaphyseal humerus fractures managed with non-vascularized fibula grafting. Risk of Bias was computed using the Joanna Briggs Institute appraisal tool.
A total of 5 studies, comprising 102 patients, were included. The pooled estimate demonstrated that 94 patients achieved bone union with intramedullary fibular strut grafting. The pooled union rate (per 100 events) was 90.59 (95 % CI, 82.86-95.04, I = 0). The present meta-analysis also showed a significant improvement in DASH scores following the use of a non-vascularized fibula graft with a common effects model (SMD = 4.08; 95%CI: 3.44; 4.72; p < 0.01 I = 19 %, p-value for Q test = 0.29).
Non-vascularized fibula grafting is an excellent adjuvant for the internal fixation of non-union diaphyseal humerus fractures. Although there is limited literature, further studies should highlight and assess the treatment of these uncommon but disabling conditions.
目前尚无处理肱骨干骨不连的标准方案，多位作者报告了他们使用各种技术和方法处理该问题的结果。尚无荟萃分析报告使用非血管化腓骨移植作为骨接合术辅助手段处理这些病例的结果。
本荟萃分析旨在估算汇总数据，以计算采用非血管化腓骨移植处理的肱骨干骨折的骨愈合率。使用乔安娜·布里格斯研究所评估工具计算偏倚风险。
共纳入5项研究，涉及102例患者。汇总估计显示，94例患者通过髓内腓骨支撑移植实现了骨愈合。汇总愈合率（每100例事件）为90.59（95%置信区间，82.86 - 95.04，I = 0）。本荟萃分析还显示，使用非血管化腓骨移植并采用共同效应模型后，DASH评分有显著改善（标准化均数差 = 4.08；95%置信区间：3.44；4.72；p < 0.01，I = 19%，Q检验p值 = 0.29）。
非血管化腓骨移植是肱骨干骨不连骨折内固定的一种优秀辅助手段。尽管相关文献有限，但进一步的研究应着重关注并评估这些不常见但致残性疾病的治疗方法。
