背景:肱骨头骨坏死(ONHH)是肱骨近端骨折(IFPHF)内固定后的严重并发症。尽管许多研究报道了风险因素,但仍存在争议。在这项研究中,荟萃分析用于评估可以修改哪些外科医生水平的因素以降低风险,我们希望为预防ONHH提供循证支持。
方法:文献检索自PubMed,科克伦图书馆,Embase,WebofScience,和Scopus为截至2023年1月发表的合格研究。计算合并的比值比(ORs)及其相应的95%置信区间(CI)进行评估。应用STATA15.1软件进行数据合成,灵敏度合成,和出版偏见。
结果:在2000年至2022年之间发表了45篇文章,最终纳入了2482例患者。所有文章都是观察性研究,有7项病例对照研究和38项队列研究,纽卡斯尔渥太华量表(NOS)评分为7至9分。汇总结果表明,年龄(OR0.32,95%CI0.14-0.74,P=0.01),还原质量(OR0.08,95%CI0.01-0.44,P=0.00),骨折类型(OR0.44,95%CI0.25-0.78,P=0.01),手术入路(OR:4.06,95%CI1.21-13.61,P=0.02)和固定植入物(OR=0.68,95%CI=0.34-1.33,P=0.02)是IFPHF后ONHH的危险因素.根据敏感性分析,Begg(P=0.42)和Egger(P=0.68)测试,结果稳定,无发表偏倚.
结论:研究表明,年龄,还原质量,骨折类型,手术入路和固定植入物是IFPHF后ONHH的危险因素,而性别,内翻或外翻,及时操作,受伤的一方,内侧支撑的存在对ONHH影响不大,因为它们不能被认为是危险因素,仍需要进一步调查。
BACKGROUND: Osteonecrosis of the humeral head (ONHH) is a severe complication after the internal fixation of proximal humeral fractures (IFPHF). The risk factors remain controversial though many studies have reported. In this research, meta-analysis was used to evaluate which surgeon-level factors can be modified to lower the risk and we hope to provide evidence-based support for preventing ONHH.
METHODS: Literature was retrieved from PubMed, Cochrane Library, Embase, Web of Science, and Scopus for eligible studies published up to January 2023. The pooled odds ratios (ORs) were calculated with their corresponding 95% confidence intervals (CIs) to evaluate. STATA 15.1 software was applied for data synthesis, sensitivity synthesis, and publication bias.
RESULTS: 45 articles were published between 2000 and 2022, and 2482 patients were finally included. All articles were observational research, with 7 case-control studies and 38 cohort studies, and the Newcastle Ottawa Scale (NOS) score ranged from 7 to 9. The pooled results suggested that age (OR 0.32, 95% CI 0.14-0.74, P = 0.01), reduction quality (OR 0.08, 95% CI 0.01-0.44, P = 0.00), fracture type (OR 0.44, 95% CI 0.25-0.78, P = 0.01), surgical approach (OR: 4.06, 95% CI 1.21-13.61, P = 0.02) and fixation implant (OR = 0.68, 95% CI = 0.34-1.33, P = 0.02) were risk factors for ONHH after IFPHF. According to sensitivity analysis, Begg (P = 0.42) and Egger (P = 0.68) tests, the results were stable and exhibited no publication bias.
CONCLUSIONS: The study showed that age, reduction quality, fracture type, surgical approach and fixation implant were risk factors for ONHH after IFPHF, while gender, varus or valgus, timely operation, injured side, and the existence of medial support have little influence on ONHH, as they could not be considered risk factors and still need further investigations.