De Joseph Jomon, Gandhi P Aravind, Padhi Bijaya K
Orthopedics, Mahatma Gandhi Medical College and Research Institute, Sri Balaji Vidyapeeth (Deemed-to-be-University), Puducherry, IND.
Community Medicine, School of Public Health, All India Institute of Medical Sciences, Nagpur, Nagpur, IND.
Cureus. 2024 Oct 24;16(10):e72251. doi: 10.7759/cureus.72251. eCollection 2024 Oct.
Proximal humeral fractures, predominantly affecting the elderly, pose significant treatment challenges due to the complex anatomy of the shoulder joint and variability in bone quality. MultiLoc nails (Synthes USA Products, West Chester, USA) are the latest construct, and PHILOS (Proximal Humerus Internal Locking System, (Synthes USA Products, West Chester, USA)) plates are the earlier construct used for the fixation of proximal humerus fractures. This systematic review aims to provide a comparison of MultiLoc nails and PHILOS plates, focusing on their effectiveness, safety, and patient outcomes. Our study included randomized controlled trials (RCTs) and observational studies comparing the effectiveness of MultiLoc nails and PHILOS plates. We searched literature in databases, including PubMed, EMBASE, and Web of Science, until December 20, 2023. The primary outcome of focus was the Neck Shaft Angle, supplemented by a range of secondary surgical and functional outcomes. The Nested Knowledge web software (Nested Knowledge, Inc., Saint Paul, USA) facilitated the screening and data extraction processes. The quality of included studies was assessed using the Cochrane Risk of Bias tool for RCTs (Cochrane, London, UK) and the ROBINS-I (Risk Of Bias In Non-randomised Studies - of Interventions) tool for observational studies (Cochrane, London, UK). R software version 4.3 (R Foundation for Statistical Computing, Vienna, Austria) was used to synthesize the collected data. Six studies met the inclusion criteria, primarily involving older adults in their mid-50s to late 70s. While MultiLoc nails offer shorter operation times and potentially reduced blood loss, both techniques effectively maintain the Neck Shaft Angle, a crucial factor for shoulder function. Comparable Constant-Murley scores and complication rates were observed between the two methods. PHILOS plates showed higher American Shoulder and Elbow Surgeons Shoulder Score (ASES) scores for two-part proximal humeral fractures with displacement. Other observations suggested advantages of MultiLoc nails in terms of faster union and fewer complications.
肱骨近端骨折主要影响老年人，由于肩关节解剖结构复杂且骨质质量存在差异，给治疗带来了重大挑战。MultiLoc髓内钉（美国辛迪思公司产品，美国韦斯特切斯特）是最新的内固定器械，而PHILOS（肱骨近端锁定接骨板系统，美国辛迪思公司产品，美国韦斯特切斯特）接骨板是较早用于固定肱骨近端骨折的器械。本系统评价旨在比较MultiLoc髓内钉和PHILOS接骨板，重点关注其有效性、安全性和患者预后。我们的研究纳入了比较MultiLoc髓内钉和PHILOS接骨板有效性的随机对照试验（RCT）和观察性研究。我们检索了包括PubMed、EMBASE和Web of Science在内的数据库中的文献，检索截止至2023年12月20日。重点关注的主要结局指标是颈干角，辅以一系列次要的手术和功能结局指标。Nested Knowledge网络软件（美国明尼苏达州圣保罗Nested Knowledge公司）辅助进行筛选和数据提取过程。使用Cochrane随机对照试验偏倚风险工具（英国伦敦Cochrane）和观察性研究的ROBINS-I（非随机干预性研究中的偏倚风险）工具（英国伦敦Cochrane）评估纳入研究的质量。使用R软件4.3版本（奥地利维也纳R统计计算基金会）对收集的数据进行综合分析。六项研究符合纳入标准，主要涉及年龄在50多岁至70多岁的老年人。虽然MultiLoc髓内钉的手术时间较短且可能减少失血，但两种技术均能有效维持颈干角，这是影响肩部功能的关键因素。两种方法的Constant-Murley评分和并发症发生率相当。对于伴有移位的两部分肱骨近端骨折，PHILOS接骨板的美国肩肘外科医师协会（ASES）评分更高。其他观察结果表明，MultiLoc髓内钉在愈合更快和并发症更少方面具有优势。
