镜下锚钉缝线桥固定肱骨大结节撕脱骨折的荟萃分析△

Arthroscopic anchor suture bridge technique for fixation of avulsion fracture of greater tuberosity of humerus: a metaanalysis

摘要:

[目的] 比较镜下锚钉缝线桥固定与切开复位内固定治疗肱骨大结节撕脱骨折的临床疗效。[方法] 计算机检索 PubMed、Cochrane、Embase、中国知网、万方及维普等数据库，收集建库至 2021 年 5 月关于两种手术方式治疗肱骨大节结撕脱骨折的文献，对纳入文献进行质量评价及数据提取，采用 RevMan5.3 软件对结局指标进行荟萃分析。[结果] 纳入 6 篇文献，共计 390 例患者，其中镜下组 188 例，切开组 202 例。荟萃分析显示：镜下组术后肩关节前屈活动度、外展活动度、90°位内旋、VAS 评分、ASES 评分以及并发症发生率方面均明显优于切开组(P＜0.05)，但手术时间较长(P＜0.05)。两组术中出血量、 肩关节后伸活动度、0°位外旋、90°位外旋方面比较差异均无统计学意义(P＞0.05)。[结论] 镜下锚钉缝线桥固定可缓解术后疼痛并促进肩关节功能恢复，有利于减少并发症的发生。但手术时间较长，手术潜在风险也会相应增加。

Abstract:

[Objective] To compare the clinical efficacy of arthroscopic anchor suture bridge technique and open reduction and inter- nal fixation in the treatment of avulsion fracture of the humeral greater tuberosity. [Methods] The databases, including PubMed, Cochrane, Embase, CNKI, Wanfang and VIP were searched by using computer to select the literatures on the treatment of avulsion fracture of humeral greater tuberosity by arthroscopic and open methods from the establishment of the database to May 2021. After the quality of the included literatures was evaluated, the data were extracted and analyzed by RevMan5.3 software. [Results] A total of 6 articles were included, involv- ing 390 patients. Of them, 188 patients received arthroscopic anchor suture bridge technique, whereas 202 patients underwent open reduc- tion and internal fixation (ORIF) . As results of meta-analysis, the arthroscopic group proved significantly superior the the ORIF group in term of shoulder flexion range of motion, abduction range of motion, 90° internal rotation,VAS score, ASES score and complication rate (P＜ 0.05) . However, the arthroscopic group consumed significantly longer operation time than the ORIF group (P＜0.05) . There was no signifi- cant difference between the two groups in intraoperative bleeding, shoulder extension range of motion, 0° external rotation and 90° external rotation (P＞0.05) . [Conclusion] Arthroscopic anchor suture bridge technique does alleviate postoperative pain and promote the recovery of shoulder function, is helpful to reduce the incidence of complications, whereas has disadvantage of longer operation time which lead to po- tential risk accordingly.