Li Yang, Luo Yi, Peng Jing, Fan Jun, Long Xiao-Tao
Department of Traumatic Orthopedics, Chongqing General Hospital, Chongqing University, Chongqing 401147, China.
Department of Orthopedics, Bishan Hospital of Chongqing, Chongqing 402760, China.
World J Orthop. 2024 Aug 18;15(8):783-795. doi: 10.5312/wjo.v15.i8.783.
Whether operation is superior to non-operation for humeral shaft fracture remains debatable. We hypothesized that operation could decrease the nonunion and reintervention rates and increase the functional outcomes.
To compare the clinical efficacy between operative and nonoperative approaches for humeral shaft fractures.
We searched the PubMed, Web of Science, ScienceDirect, and Cochrane databases from 1990 to December 2023 for clinical trials and cohort studies comparing the effects of operative and conservative methods on humeral shaft fractures. Two investigators independently extracted data from the eligible studies, and the other two assessed the methodological quality of each study. The quality of the included studies was assessed using the Cochrane risk bias or Newcastle-Ottawa Scale. The nonunion, reintervention and the overall complications and functional scores were pooled and analyzed using Review Manager software (version 5.3).
A total of four randomized control trials and 13 cohort studies were included, with 1285 and 1346 patients in the operative and nonoperative groups, respectively. Patients in the operative group were treated with a plate or nail, whereas those in the conservative group were managed with splint or functional bracing. Four studies were assessed as having a high risk of bias, and the other 13 were of a low risk of bias according to the Newcastle-Ottawa Scale or Cochrane risk bias tool. The operative group had a significantly decreased rate of nonunion [odds ratio (OR) 0.30; 95%CI: 0.23 to 0.40), reintervention (OR: 0.33; 95%CI: 0.24 to 0.47), and overall complications (OR: 0.62; 95%CI: 0.49 to 0.78)]. The pooled effect of the Disabilities of Arm, Shoulder, and Hand score showed a significant difference at 3 [mean difference (MD) -8.26; 95%CI: -13.60 to -2.92], 6 (MD: -6.72; 95%CI: -11.34 to -2.10), and 12 months (MD: -2.55; 95%CI: -4.36 to -0.74). The pooled effect of Visual Analog Scale scores and the Constant-Murley score did not significantly differ between the two groups.
This systematic review and meta-analysis revealed a trend of rapid functional recovery and decreased rates of nonunion and reintervention after operation for humeral shaft fracture compared to conservative treatment.
肱骨干骨折手术治疗是否优于非手术治疗仍存在争议。我们假设手术可以降低骨不连和再次干预率，并提高功能结局。
比较肱骨干骨折手术和非手术治疗方法的临床疗效。
我们检索了1990年至2023年12月的PubMed、Web of Science、ScienceDirect和Cochrane数据库，以查找比较手术和保守方法治疗肱骨干骨折效果的临床试验和队列研究。两名研究人员独立从符合条件的研究中提取数据，另外两名研究人员评估每项研究的方法学质量。使用Cochrane风险偏倚或纽卡斯尔-渥太华量表评估纳入研究的质量。使用Review Manager软件（5.3版）汇总并分析骨不连、再次干预、总体并发症和功能评分。
共纳入四项随机对照试验和13项队列研究，手术组和非手术组分别有1285例和1346例患者。手术组患者采用钢板或髓内钉治疗，而保守组患者采用夹板或功能支具治疗。根据纽卡斯尔-渥太华量表或Cochrane风险偏倚工具，四项研究被评估为具有高偏倚风险，其他13项研究为低偏倚风险。手术组的骨不连率[比值比（OR）0.30；95%CI：0.23至0.40]、再次干预率（OR：0.33；95%CI：0.24至0.47）和总体并发症率（OR：0.62；95%CI：0.49至0.78）显著降低。上肢、肩部和手部功能障碍评分的合并效应在3个月时显示出显著差异[平均差（MD）-8.26；95%CI：-13.60至-2.92]、6个月时（MD：-6.72；95%CI：-11.34至-2.10）和12个月时（MD：-2.55；95%CI：-4.36至-0.74）。视觉模拟量表评分和Constant-Murley评分的合并效应在两组之间没有显著差异。
这项系统评价和荟萃分析表明，与保守治疗相比，肱骨干骨折手术后功能恢复较快，骨不连和再次干预率降低。
