Guo Jiankuo, Ma Hua
Department of Neurosurgery, Huaihe Hospital of Henan University, Kaifeng, China.
Department of Laboratory Medicine, Kaifeng Tuberculosis Control Center, Kaifeng, China.
Medicine (Baltimore). 2025 Jan 17;104(3):e40948. doi: 10.1097/MD.0000000000040948.
The main treatment methods for humeral shaft fractures include minimally invasive plate osteosynthesis (MIPO), intramedullary nailing (IMN), open reduction and internal fixation (ORF), and non-operative treatment (NonOP). However, the optimal treatment plan remains unclear. This article utilizes a network meta-analysis to compare the therapeutic effects of MIPO, IMN, ORF, and NonOP for the treatment of humeral shaft fractures.
We searched electronic databases, including the PubMed, Embase, The Cochrane Library, and the Web of Science Databases, from inception to June 1, 2024. The "Risk of Bias Assessment" tool recommended by the Cochrane Collaboration was used to evaluate the quality of the included literature. RevMan 5.4 software and R software with gemtc package was used for the graphical representation and data analysis of the network meta-analysis.
A total of 23 randomized controlled trials were finally included. The results indicated that the efficacy of disabilities of the arm, shoulder and hand score was significantly higher in the MIPO group than in the open reduction and internal fixation (ORIF) group (weighted mean difference = 4.7, 95% confidence intervals, 1.8-7.75). IMN was associated with a decrease of the constant-Murley scores score than NonOP (weighted mean difference = -4.4, 95% confidence intervals, -8.7 to -0.068). IMN, MIPO, and ORIF was associated with a decrease of the fracture healing time than NonOP. The difference for nonunion rate and iatrogenic radial nerve injuries between any 2 groups was not statistically significant (P > .05).
The evidence from current meta-analysis indicated that ORIF provides the best recovery effects for upper limb and shoulder joint function after the treatment of humeral shaft fractures, with the drawback of a relatively higher incidence of complications. To ensure the reliability of this study's results, more high-quality randomized controlled trials are needed in the future to verify these findings.
肱骨干骨折的主要治疗方法包括微创钢板接骨术（MIPO）、髓内钉固定术（IMN）、切开复位内固定术（ORF）和非手术治疗（NonOP）。然而，最佳治疗方案仍不明确。本文采用网状Meta分析比较MIPO、IMN、ORF和NonOP治疗肱骨干骨折的疗效。
检索电子数据库，包括PubMed、Embase、Cochrane图书馆和Web of Science数据库，检索时间从建库至2024年6月1日。采用Cochrane协作网推荐的“偏倚风险评估”工具评估纳入文献的质量。使用RevMan 5.4软件和带有gemtc包的R软件进行网状Meta分析的图形表示和数据分析。
最终共纳入23项随机对照试验。结果表明，MIPO组的上肢、肩部和手部功能障碍评分的疗效显著高于切开复位内固定术（ORIF）组（加权平均差=4.7，95%置信区间，1.8-7.75）。与非手术治疗相比，IMN与Constant-Murley评分降低相关（加权平均差=-4.4，95%置信区间，-8.7至-0.068）。与非手术治疗相比，IMN、MIPO和ORIF与骨折愈合时间缩短相关。任意两组之间的骨不连发生率和医源性桡神经损伤差异无统计学意义（P>.05）。
当前Meta分析的证据表明，切开复位内固定术在肱骨干骨折治疗后为上肢和肩关节功能提供了最佳恢复效果，缺点是并发症发生率相对较高。为确保本研究结果的可靠性，未来需要更多高质量的随机对照试验来验证这些发现。
