Abstract:
This study aims to provide an updated review comparing the complication rates and clinical outcomes of intramedullary nails and locking plates (LPs) in displaced proximal humerus fracture (PHF) management. We performed a systematic review of the Cochrane Central Register of Controlled Trials, Clinical Trials Registry, EMBASE, and PubMed. Studies with level III evidence or higher comparing intramedullary nails and LPs used for internal fixation of displaced PHFs were included. The Methodological Index for Nonrandomized Studies (MINORS) criteria and Cochrane Handbook for Systematic Reviews of Interventions 5.2.0 were used to assess the risk of bias. Our meta-analysis included a comparison of method-related complications, pain scores, range of motion (ROM), and functional scores. A total of 13 comparative studies were included: five randomized controlled trials, three prospective cohort studies, and five retrospective cohort studies. The total number of patients included was 1,253 (677 in the LP group and 576 in the intramedullary nail group). Superior Constant-Murley scores and external rotation ROM were found in the LP group during the early postoperative period. However, long-term functional scores and complication rates were comparable between the two groups. We conclude that intramedullary nailing and LP fixation are both equally effective for the treatment of displaced PHFs. Neither treatment appears superior at this time, and more large-scale randomized controlled trials should be conducted to further evaluate the potential benefit of LPs in the early postoperative period.
摘要:
这项研究旨在提供最新的综述,比较髓内钉和锁定钢板(LP)在移位肱骨近端骨折(PHF)治疗中的并发症发生率和临床结果。我们对Cochrane中央对照试验登记册进行了系统评价,临床试验注册,EMBASE,和PubMed。包括比较髓内钉和用于移位PHF内固定的LP的III级或更高水平证据的研究。非随机研究方法学指数(MINORS)标准和Cochrane干预措施系统评价手册5.2.0用于评估偏倚风险。我们的荟萃分析包括方法相关并发症的比较,疼痛评分,运动范围(ROM),和功能分数。共纳入13项比较研究:5项随机对照试验,三项前瞻性队列研究,和五项回顾性队列研究。纳入的患者总数为1,253例(LP组677例,髓内钉组576例)。LP组在术后早期发现了出色的Constant-Murley评分和外部旋转ROM。然而,两组的长期功能评分和并发症发生率具有可比性.我们得出的结论是,髓内钉和LP固定对于治疗移位的PHF同样有效。此时两种治疗方法都没有优势,应进行更多的大规模随机对照试验,以进一步评估LPs在术后早期的潜在益处.