CAJ | 학술논문

目的对采用肱骨近端锁定钢板(LPHP)或肱骨近端内锁定系统(PHILOS)与其他内固定治疗肱骨近端骨折(PHFs)的疗效进行Meta分析,为临床治疗提供参考依据. 方法通过计算机检索MEDLINE(1966年至2011年12月)、EMbase(1966年至2011年12月)、Cochrane图书馆(2011年第4期)和中国生物医学文献数据库(2001至2011年)等,搜集有关LPHP/PHILOS和其他内固定治疗PHFs的各种对照研究,对纳入的文献选择Neer评分、Constant-Murley功能评分、肩关节疼痛和功能障碍指数(SPADI)量表和美国肩肘外科医师(ASES)评分、异位骨化发生率、感染率、肱骨头缺血坏死率、骨折延迟愈合率、螺钉松动率、钢板断裂率、肩峰下撞击征发生率、肱骨头半脱位发生率、肩关节活动受限发生率、肩关节疼痛发生率、二次手术率作为Meta分析的评价指标,采用RevMan 5.0进行分析. 结果共纳入18项研究1133例患者.LPHP/PHILOS与其他内固定治疗PHFs相比,螺钉松动率更低,差异均有统计学意义[OR=0.23,95％ CI(O.07,0.74),P=O.01].LPHP/PHILOS与其他内固定治疗PHFs的Neer评分优良率、异位骨化发生率、感染率、肱骨头缺血坏死率、骨折延迟愈合率、钢板断裂率、肩峰撞击征发生率、肱骨头半脱位发生率、肩关节活动受限发生率比较,差异均无统计学意义(P＞0.05). 结论 LPHP/PHILOS与其他内固定在特定条件下各有利弊,不能盲目扩大LPHP/PHILOS的临床适应证,治疗方案要结合患者的病情甚至经济情况综合考虑.
목적 대채용굉골근단쇄정강판(LPHP)혹굉골근단내쇄정계통(PHILOS)여기타내고정치료굉골근단골절(PHFs)적료효진행Meta분석,위림상치료제공삼고의거. 방법 통과계산궤검색MEDLINE(1966년지2011년12월)、EMbase(1966년지2011년12월)、Cochrane도서관(2011년제4기)화중국생물의학문헌수거고(2001지2011년)등,수집유관LPHP/PHILOS화기타내고정치료PHFs적각충대조연구,대납입적문헌선택Neer평분、Constant-Murley공능평분、견관절동통화공능장애지수(SPADI)량표화미국견주외과의사(ASES)평분、이위골화발생솔、감염솔、굉골두결혈배사솔、골절연지유합솔、라정송동솔、강판단렬솔、견봉하당격정발생솔、굉골두반탈위발생솔、견관절활동수한발생솔、견관절동통발생솔、이차수술솔작위Meta분석적평개지표,채용RevMan 5.0진행분석. 결과 공납입18항연구1133례환자.LPHP/PHILOS여기타내고정치료PHFs상비,라정송동솔경저,차이균유통계학의의[OR=0.23,95％ CI(O.07,0.74),P=O.01].LPHP/PHILOS여기타내고정치료PHFs적Neer평분우량솔、이위골화발생솔、감염솔、굉골두결혈배사솔、골절연지유합솔、강판단렬솔、견봉당격정발생솔、굉골두반탈위발생솔、견관절활동수한발생솔비교,차이균무통계학의의(P＞0.05). 결론 LPHP/PHILOS여기타내고정재특정조건하각유리폐,불능맹목확대LPHP/PHILOS적림상괄응증,치료방안요결합환자적병정심지경제정황종합고필.
Objective To evaluate and compare locking proximal humerus plate/proximal humeral internal locking system (LPHP/PHILOS) versus other internal fixations in the treatment of proximal humeral fractures (PHFs) in adults.Methods According to Cochrane Reviews,Cochrane library (Issue 4,2011),Ovid MEDLINE (from January 1966 to December 2011),EMbase (from January 1966 to December 2011),Chinese National Knowledge Infrastructure (CNKI,from January 2001 to December 2011),VIP database (from January 2001 to December 2011),and Chinese Biomedical Database (CBM,from January 2001 to December 2011) were searched for randomized controlled trials (RCTs),quasi randomized controlled trials (Quasi-RCTs) and non-randomized controlled trials (Non-RCTs) comparing LPHP/PHILOS versus other internal fixations for the treatment of proximal humeral fractures.Software RevMan 5.0 was used to analyze the trials included in terms of Neer score,Constant-Murley functional score,shoulder pain and disability index (SPADI),American Shoulder and Elbow Surgeons (ASES)score,heterotopic ossification,infection,humeral ischemic necrosis,delayed union,subacromial impingement,screw loosening,plate breakage,humeral semiluxation,shoulder motion limitation,shoulder pain and secondary operation.Results A total of 18 non-RCTs comparing LPHP/PHILOS and other internal fixations for treatment of adult PHF were included in this systematic review.Data analyses showed that LPHP/PHILOS had a significantly lower rate of screw loosening than the other fixations [OR =0.23,95％ CI(O.07,0.74),P =0.01].There were no significant differences between LPHP/PHILOS and the other fixations regarding Neer score,heterotopic ossification,infection,humeral ischemic necrosis,delayed union,plate breakage,subacromial impingement,humeral semiluxation and shoulder motion limitation (P ＞ 0.05).Conclusions LPHP/PHILOS and other internal fixations have their own advantages and disadvantages in the PHF treatment and the current literature offer no robust evidence to support use of LPHP/PHILOS over other internal fixations for PHFs.LPHP/PHILOS should be used after careful considerations of the patient's injury,economic status and demands.