Multiloc intramedullary nail versus PHILOS locking plate in the treatment of proximal humerus fracture: a meta-analysis

doi:10.3969/j.issn.2095-4344.1961

Abstract

Abstract:

BACKGROUND: Proximal humerus fracture is the third major fracture type after hip fracture and distal radius fracture in the elderly. The treatment of proximal humeral fractures is diverse. The latest research in recent years has found that the third-generation multi-dimensional locking humeral intramedullary nail system has shown good clinical results in the treatment of proximal humeral fractures, but the current optimal treatment for proximal humeral fractures remains controversial.

OBJECTIVE: To systematically evaluate the clinical efficacy of Multiloc intramedullary nail versus PHILOS locking plate in the treatment of proximal humeral fractures.

METHODS: The electronic databases of CNKI, Wanfang, VIP, PubMed, Embase, and the Cochrane library, which last updated in February, 2019, were searched for clinical controlled trials regarding Multiloc intramedullary nail versus PHILOS locking plate in the treatment of proximal humerus fracture. The methodological quality of each publication was critically appraised using the Newcastle-Ottawa Scale appraisal tool and a meta-analysis was performed with the Cochrane Collaboration's Rev Man 5.3 software.

RESULTS AND CONCLUSION: (1) Eight studies including 267 patients were analyzed. (2) The results of meta-analysis revealed that Multiloc intramedullary nail group had significantly better outcomes in Constant score (MD=1.98(0.65, 3.31), P=0.004), American Shoulder and Elbow Surgeons shoulder score [MD=3.59(1.61, 5.57), P=0.000 4], external rotation (MD=4.55(2.19, 6.91), P=0.000 2), operation time [MD=-13.11(-25.47, -0.74), P=0.04), healing time [SMD=-0.46(-0.47, -0.18), P=0.001), and blood loss [MD=-66.44(-102.25, -36.62), P < 0.000 1) than the PHILOS plate group. (3) However, there were no significant differences in Visual Analogue Scale scores, anterior flexion and uplifting flexion, and adverse reactions between the Multiloc intramedullary nail and PHILOS plate groups (P > 0.05). (4) Results of meta-analysis showed that compared with PHILOS locking plate, Multiloc intramedullary nail had the advantages of shorter operation time, less bleeding, quicker recovery of shoulder function, and faster healing time, but the incidence of postoperative acromion impingement, screw cut, humeral head necrosis and varus deformity was similar between these two groups. Relatively speaking, Multiloc intramedullary nails have a better clinical outcome than PHILOS locking plate.

Key words: Multiloc intramedullary nail, PHILOS locking plate, proximal humerus fracture, mobility, fracture, meta-analysis, systematic review

CLC Number:

R459.9|R318|R683.4

Fang Zhirong, Jiang Tao, Hong Weiwu, Huang Yongquan, Peng Jiajie, Liu Zitao, Zhou Lin, Liang Yihao, Su Haitao. Multiloc intramedullary nail versus PHILOS locking plate in the treatment of proximal humerus fracture: a meta-analysis[J]. Chinese Journal of Tissue Engineering Research, 2019, 23(36): 5896-5904.

Figures/Tables 6

2.2.2 肩关节活动度 (1)肩关节前屈上举活动：共有5篇文献报道了末次随访肩关节前屈上举活动功能[9-10，13-14，16]，异质性检验结果提示组间异质性较小(P=0.49，I2=0%)，采用固定效应模型合并效应量。Meta分析结果显示，Multiloc髓内钉组在肩关节前屈上举活动方面与PHILOS钢板组相比差异无显著性意义[MD=2.43(-0.46，5.33)，P=0.10]，见图5。 (2)肩关节外旋活动：共有5篇文献报道了末次随访肩关节外旋活动[9-10，13-14，16]，异质性检验结果提示组间异质性较小(P=0.12，I2=46%)，采用固定效应模型合并效应量。Meta分析结果显示，Multiloc髓内钉组在肩关节外旋活动方面优于PHILOS钢板组，2组间差异有显著性意义[MD=4.55(2.19，6.91)，P=0.000 2]，见图6。 (3)肩关节外展活动：共有3篇文献报道了末次随访肩关节外展活动[9-10，16]，异质性检验结果提示组间异质性较高(P=0.08，I2=60%)，采用随机效应模型合并效应量。Meta分析结果显示，Multiloc髓内钉组在肩关节外展活动度与PHILOS钢板组相比差异无显著性意义[MD=-10.06(-26.74，6.62)，P=0.24]，见图7。 2.2.3 不良反应 (1)总体不良反应发生率：共有5篇文献报道了总体不良反应事件[11，13-16]，异质性检验结果提示组间异质性较小(P=0.70，I2=0%)，采用固定效应模型合并效应量。Meta分析结果显示，Multiloc髓内钉组在总体不良反应发生率方面与PHILOS钢板组比较差异无显著性意义[OR=0.95 (0.41，2.18)，P=0.90]，见图8。 (2)肩峰撞击症：共有3篇文献报道了肩峰撞击事件[11， 14-15]，异质性检验结果提示组间异质性较小(P=0.52，I2=0%)，采用固定效应模型合并效应量。Meta分析结果显示，Multiloc髓内钉组在术后肩峰撞击发生率方面与PHILOS钢板组比较差异无显著性意义[OR=2.20(0.60，8.01)，P=0.23]，见图9。 "

References

[1]Bell JE, Leung BC, Spratt KF, et al. Trends and variation in incidence, surgical treatment, and repeat surgery of proximal humeral fractures in the elderly. J Bone Joint Surg Am. 2011;2: 121-131.

[2]Palvanen M, Kannus P, Niemi S, et al. Update in the epidemiology of proximal humeral fractures. Clin Orthop Relat Res. 2006;442:87-92.

[3]Gracitelli M, Malavolta EA, Assuncao JH, et al. Locking intramedullary nails versus locking plates for the treatment of proximal humerus fractures. Expert Rev Med Dev. 2017;9: 733-739.

[4]Hessmann MH, Nijs S, Mittlmeier T, et al. Internal fixation of fractures of the proximal humerus with the multiloc nail. Oper Orthop Traumatol. 2012;4-5:418-431.

[5]Gupta AK, Harris JD, Erickson BJ, et al. Surgical management of complex proximal humerus fractures-a systematic review of 92 studies including 4500 patients. J Orthop Trauma. 2015;1: 54-59.

[6]Sun JC, Li YL, Ning GZ, et al. Treatment of Three- and Four-Part Proximal Humeral Fractures with Locking Proximal Humerus Plate. Eur J Orthop Surg Traumatol. 2013;6:699-704.

[7]Handoll H, Brorson S. Interventions for treating proximal humeral fractures in adults. Cochrane Database Syst Rev. 2015;(11):CD000434.

[8]Stang A. Critical evaluation of the Newcastle-Ottawa Scale for the assessment of the quality of nonrandomized studies in meta-analyses. Eur J Epidemiol. 2010;9:603-605.

[9]李一平,向明,杨国勇,等.内翻型肱骨近端骨折的治疗:锁定钢板与髓内钉的临床效果[J]. 中国运动医学杂志, 2018,37(11): 945-950.

[10]邹义源,向明,陈杭,等.Neer二部分肱骨外科颈骨折微创治疗: Phlios钢板与Multiloc髓内钉对比[J]. 中国组织工程研究, 2018, 22(19):2981-2987.

[11]张荣平. Multiloc髓内钉与锁定钢板治疗老年肱骨近端骨折的早期疗效[J]. 临床医学研究与实践, 2018,3(20):54-56.

[12]许猛子,周君琳,宋华伟,等.Multiloc髓内钉与Philos锁定钢板治疗肱骨近端骨折疗效对比研究[J]. 国际外科学杂志, 2018,45(3): 168-172.

[13]陈杭,向明,胡晓川,等.Philos钢板与Multiloc髓内钉治疗中老年肱骨近端三?四部分骨折的疗效比较[J].中华创伤杂志,2018,34 (12):1067-1074.

[14]张伟,范建波,崔志明,等.MultiLoc髓内钉与 PHILOS 钢板治疗肱骨近端骨折的早期疗效比较[J]. 中国骨与关节杂志, 2018,7(11): 811-815.

[15]赵东升,郑晓勇,余清文,等.Multiloc髓内针治疗老年肱骨近端骨折的临床疗效[J]. 实用骨科杂志, 2017,23(5):453-455.

[16]向明,杨国勇,邹义源,等.锁定钢板与髓内钉治疗肱骨近端骨折的疗效比较[J]. 中华骨科杂志, 2017,37(21):1333-1341.

[17]丁国庆,李晓林.老年肱骨近端骨折治疗进展[J]. 国际骨科学杂志, 2011,32(6):372-374, 383.

[18]Konrad G, Audige L, Lambert S, et al. Similar outcomes for nail versus plate fixation of three-part proximal humeral fractures. Clin Orthop Relat Res. 2012;2:602-609.

[19]林浩东,周军.老年肱骨近端骨折的最佳治疗方案选择[J]. 中国骨与关节杂志, 2018,7(11):801-803.

[20]Li M, Wang Y, Zhang Y, et al. Intramedullary nail versus locking plate for treatment of proximal humeral fractures: a meta-analysis based on 1384 individuals. J Int Med Res. 2018; 11:4363-4376.

[21]Yoon RS, Dziadosz D, Porter DA, et al. A comprehensive update on current fixation options for two-part proximal humerus fractures. Injury. 2014;45(3):510-514.

[22]Sun Q, Ge W, Li G, et al. Locking plates versus intramedullary nails in the management of displaced proximal humeral fractures: a systematic review and meta-analysis. Int Orthop. 2018;3:641-650.

[23]Maier D, Jaeger M, Izadpanah K, et al. Proximal humeral fracture treatment in adults. J Bone Joint Surg Am. 2014; 3: 251-261.

[24]Burkhart KJ, Dietz SO, Bastian L, et al. The treatment of proximal humeral fracture in adults. Deutsch Arztebl Int. 2013; 35-36:591-597.

[25]Wang G, Mao Z, Zhang L, et al. Meta-analysis of locking plate versus intramedullary nail for treatment of proximal humeral fractures. J Orthop Surg Res. 2015;10:122.

[26]王伟,陈永佳,沈磊,等.微创钢板内固定与传统手术治疗成人肱骨干骨折的系统评价[J].中国组织工程研究, 2018,22(35): 5715-5723.

[27]罗世彤,高宏,刘峰瑞,等.髓内钉与锁定钢板治疗肱骨近端两部分骨折疗效的Meta分析[J].中华创伤杂志, 2016,32(12): 1073-1079.

[28]焦庆丰,白鹏程,张媺,等.Philos钢板治疗肱骨近端骨折疗效分析[J]. 临床骨科杂志,2016,19(3):336-337.

[29]Lowe JB, Monazzam S, Walton B, et al. How to use fluoroscopic imaging to prevent intraarticular screw perforation during locked plating of proximal humerus fractures: a cadaveric study. J Orthop Trauma. 2015;10:e401-e407.

[30]王富强,孙斌,孔凡强.分叉交锁髓内钉与锁定钢板对肱骨骨折患者生物力学比较研究[J]. 中华保健医学杂志, 2018,20(3):203-205.

[31]高峰,王秀会,夏胜利,等.锁定钢板与髓内钉治疗肱骨近端骨折的比较[J]. 中国矫形外科杂志, 2018,26(12):1068-1073.

[32]余德涛,王雷,邢帧全.锁定钢板与弹性髓内钉对桡神经损伤性肱骨骨折临床疗效比较研究[J]. 检验医学与临床, 2018,15(11): 1640-1643.