肱骨近端锁定系统与锁定肱骨近端钢板的荟萃分析

A meta-analysis on proximal humerus interlocking systems versus locking proximal humerus plates

摘要:

[目的] 采用荟萃分析评价肱骨近端锁定系统 （proximal humeral interlocking system, PHILOS） 和锁定肱骨近端钢板 （locking proximal humerus plate, LPHP）治疗老年肱骨近端骨折的临床疗效。[方法]检索 Pubmed、Embase、中国生物医学文献数据库、中国知网、维普数据库、万方数据库自建库至 2024 年 4 月有关国内外文献，采用 RevMan5.3 软件对纳入文献行荟萃分析。[结果]共纳入 11 篇文献，均为队列研究。荟萃分析结果显示：PHILOS 组手术时间（SMD=-1.32, 95%CI: -2.28~-0.37, P= 0.007）、术中出血量 （SMD=-1.23, 95%CI: -1.79~-0.67, P＜0.001）、骨折愈合时间 （SMD=-1.23, 95%CI: -1.79~-0.67, P＜0.001）、 术后并发症（OR=0.43, 95%CI: 0.27~0.68, P＜0.001）、术后优良率（OR=4.45, 95%CI: 2.47~8.04, P＜0.001）、术后肩关节外旋活动度 （SMD=1.20, 95%CI: 0.32~2.08, P=0.007）、术后肩关节屈曲上举活动度（MD=4.58, 95%CI: 2.99~6.17, P＜0.001）、术后日常生活能力 （MD=1.47, 95%CI: 1.06~1.89, P＜0.001）、术后肌力 （MD=1.18, 95%CI: 0.67~1.69, P＜0.001）、术后引流量 （SMD=-0.57, 95%CI: -0.90~-0.24, P＜0.001）均显著优于 LPHP 组，而两组术后 CMS、VAS 评分的差异无统计学意义（P＞0.05）。[结论]本研究表明肱骨近端骨折固定 PHILOS 临床效果优于 LPHP。

Abstract:

[Objective] To compare the clinical consequence of proximal humeral internal locking system (PHILOS) versus locking proximal humerus plate (LPHP) for proximal humerus fractures in the elderly by meta- analysis. [Methods] Relevant literatures at home and abroad were retrieved from Pubmed, Embase, China Biomedical Literature Database, CNKI, VIP Database and Wanfang Database from database establishing to April 2024, and a meta-analysis was performed on the included literatures by RevMan5.3 software. [Results] A total of 11 literatures were included, all of which were cohort studies. As results of the meta-analysis, the PHILOS group proved significantly superior to the LPHP in terms of operative time (SMD=-1.32, 95%CI: -2.28~0.37, P=0.007), intraoperative blood loss (SMD=-1.23, 95% CI: -1.79~0.67, P＜0.001), fracture healing time (SMD=-1.23, 95%CI: -1.79~0.67, P＜0.001), postoperative complications (OR=0.43, 95% CI: 0.27~0.68, P＜0.001), postoperative excellent and good rate (OR=4.45, 95% CI: 2.47~8.04, P＜0.001), postoperative external rotation ROM of the shoulder (SMD=1.20, 95%CI: 0.32~2.08, P=0.007), postoperative upward elevation ROM of the shoulder (MD=4.58, 95%CI: 2.99~6.17, P＜0.001), postoperative activity of daily living scale (ALD) (MD=1.47, 95% CI: 1.06~1.89, P＜0.001), postoperative muscle strength (MD=1.18, 95%CI: 0.67~1.69, P＜0.001), and postoperative drainage volume (SMD=-0.57, 95%CI: -0.90~-0.24, P＜0.001). However, there was no significant difference in CMS and VAS score between the two groups (P＞0.05). [Conclusion] This study shows that PHILOS is more effective than LPHP in internal fixation of proximal humerus fractures