Minimally invasive plate osteosynthesis versus traditional surgical method for adult humeral shaft fractures: a meta-analysis

doi:10.3969/j.issn.2095-4344.1019

Abstract

Abstract:

BACKGROUND: There are many clinical studies comparing the treatment outcomes of minimally invasive plate osteosynthesis and traditional surgical method for humeral shaft fracture, but which treatment is optimal remains controversial. Therefore, it is necessary to systematically evaluate the curative effect of two kinds of surgical methods.

OBJECTIVE: To compare the clinical outcomes between minimally invasive plate osteosynthesis and conventional fixation techniques (intramedullary nail fixation and open reduction and plate osteosynthesis) for primary humeral shaft fractures surgery.

METHODS: A computer-based search was performed in PubMed, EMBASE, ClinicalTrials. gov, Web of Science, Cochrane and CNKI databases for the articles published prior to March 10, 2018. Two authors screened articles in accordance with inclusion and exclusion criteria independently. Meta-analysis was performed on RevMan 5.3.5 software.

RESULTS AND CONCLUSION: (1) Three randomized controlled trials and three prospective cohort studies were enrolled, involving 324 patients. (2) Meta-analysis results showed that the minimally invasive plate osteosynthesis reduced the incidence of iatrogenic radial nerve injury compared with the conventional fixation techniques (RR=0.35, 95%CI=0.13-0.96, P=0.87, I²=0%). No difference was found in the indices of nonunion, malunion, healing time, operation time, superficial infection, deep infection, implant failure and postoperative functional scores between minimally invasive plate osteosynthesis and conventional fixation techniques. (3) Our results indicate that minimally invasive plate osteosynthesis can reduce the incidence of iatrogenic radial nerve injury compared with conventional fixation techniques. But the healing of fracture, infection, implant failure and functional scores show no significant difference between two methods. Randomized controlled trials with large sample size are needed to confirm these findings.

中国组织工程研究杂志出版内容重点：人工关节；骨植入物；脊柱；骨折；内固定；数字化骨科；组织工程

Key words: Humeral Fractures, Surgical Procedures, Minimally Invasive, Internal Fixators, Meta-Analysis, Tissue Engineering

CLC Number:

R459.9

Wang Wei, Chen Yongjia, Shen Lei, Lu Zhengfeng, Li Liubing. Minimally invasive plate osteosynthesis versus traditional surgical method for adult humeral shaft fractures: a meta-analysis [J]. Chinese Journal of Tissue Engineering Research, 2018, 22(35): 5715-5723.

Figures/Tables 6

2.3 Meta分析结果 2.3.1 术后愈合情况 6篇文章报道了愈合率[12-17]，结果显示MIPO与传统方法差异无显著性意义(RR=1.05，95%CI 0.99-1.10)，且没有异质性(P=0.75，I2=0%)。亚组结果分析也表明，髓内钉固定组(RR=1.05，95%CI 0.95-1.17，P=0.95，I2=0%)和切开复位钢板内固定组(RR=1.04，95%CI 0.98-1.11，P=0.49，I2=0%)差异也无显著性意义，见图4。2篇文章报道了术后的骨折愈合时间[13，15]，结果显示差异无显著性意义且异质性一般(SMD=-0.10，95%CI -0.61-0.41，P=0.17，I2=46%)，见图5。4篇文章报道了畸形愈合的发生率[12-14，16]，3篇文章的数据没有统计学意义[12，14，16]，合并数据后显示畸形愈合的发生率差异无显著性意义(RR=0.96，95%CI 0.06- 14.43)，见图6。 2.3.2 医源性桡神经损伤 6篇研究均报道了医源性桡神经损伤[12-17]，结果显示MIPO组医源性桡神经损伤发生率比传统组低(RR=0.35，95%CI 0.13-0.96，P=0.87，I2=0%)。但亚组分析结果显示MIPO与髓内钉固定(RR=0.31，95%CI 0.05-1.89，P=0.98，I2=0%)和MIPO与切开复位钢板内固定(RR=0.37，95%CI 0.11-1.23，P=0.88，I2=0%)差异无显著性意义，见图7。 2.3.3 术后感染 5篇文章报道了深部感染的发生率[12-16]，数据分析后显示2组术后深部感染的发生率差异无显著性意义(RR=0.55，95%CI 0.12-2.57)，异质性较低(P=0.23，I2=31.9%)，亚组分析结果差异也无显著性意义，见图8。只有1篇文章报道了浅部感染的发生率[12]，结果显示浅部感染的发生率差异无显著性意义(RR=0.30，95%CI 0.01-7.02)，见图9。 2.3.4 置入失败 2篇文章报道了置入失败的发生率[13，16]，结果差异无显著性意义且异质性较低(RR=1.65，95%CI 0.23-11.98，P=0.58，I2=0%)，亚组分析差异无显著性意义，见图10。 2.3.5 手术时间 3篇文章报道了手术时间[13，15，17]，Meta分析结果显示MIPO与传统术式的手术时间差异无显著性意义，但具有明显的异质性(P < 0.000 01，I2=95%)，亚组分析结果显示MIPO手术比髓内钉固定方法的手术时间短(SMD=-2.71，95%CI -3.52至-1.90)，而MIPO与切开复位钢板内固定的手术时间差异无显著性意义(SMD=-0.01，95%CI -0.97-0.95)，但是异质性过于明显(P=0.01，I2= 84%)，见图11。 2.3.6 功能评分 2篇文章报道了美国加州大学肩关节评分(UCLA评分)[12，15]，结果显示差异无显著性意义且异质性一般(SMD=0.15，95%CI -0.23-0.54，P=0.64，I2=0%)，见图12。美国肩肘外科医师评分[17]、Mayo肘关节功能评分和Constant肩评分各只有1篇文献报道[15，17]，结果显示差异均无显著性意义，见图13-15。"

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