Minimally invasive percutaneous plate osteosynthesis versus open reduction internal fixation through dehopectoral approach for proximal humeral fracture: a meta-analysis

doi:10.3969/j.issn.2095-4344.1113

Abstract

Abstract:

BACKGROUND: Conventional deltopectoral approach for reduction and internal fixation is widely used in clinical practice. Anterolateral deltoid-split approach is a new technique emerging in recent years, and whether it has advantages in the treatment of proximal humeral fractures remains controversial.

OBJECTIVE: To compare the efficacy of minimally invasive percutaneous plate osteosynthesis versus open reduction internal fixation through dehopectoral approach for proximal humeral fracture using a meta-analysis.

METHODS: Medline, EMBASE, the Cochrane Library, Cochrane Register, CBM, and CNKI databases were retrieved for the clinical trials concerning the efficacy of percutaneous plate osteosynthesis versus open reduction internal fixation through dehopectoral approach for proximal humeral fracture published from January 1995 to December 2017. The studies were screened according to the inclusion and exclusion criteria and methodology quality was performed. A meta-analysis was conducted on and Review Manager 5.3.2 software.

RESULTS AND CONCLUSION: (1) Twenty-one studies involving 1 625 patients (minimally invasive group, n=808; conventional group, n=817) were included. (2) The meta-analysis results showed that the minimally invasive group was significantly superior to the conventional group in the operation time, intraoperative blood loss, postoperative Visual Analogue Scale scores, fracture healing time, the incidence of humeral head osteonecrosis, and the Constant scores at postoperative 3 months (P < 0.05). (2) There were no significant differences in the Constant scores at postoperative 12 months and complications between two groups (P > 0.05). (4) In summary, compared with the traditional open reduction internal fixation, minimally invasive percutaneous plate osteosynthesis has advantages of minimal trauma and short-term effects. There is no significant difference in the long-term curative effect or complications. Due to part of the literature is not high-quality randomized controlled trails, the conclusion may exist bias; therefore, more high-quality randomized controlled trials are required to draw more reliable conclusions.

Key words: Humeral Fractures, Fracture Fixation, Internal Fixators, Tissue Engineering

CLC Number:

R459.9

Shu Li, Ju Xiaochen, Wu Ping, Zhang Lei. Minimally invasive percutaneous plate osteosynthesis versus open reduction internal fixation through dehopectoral approach for proximal humeral fracture: a meta-analysis [J]. Chinese Journal of Tissue Engineering Research, 2019, 23(12): 1961-1968.

Figures/Tables 3

2.2.4 骨折愈合时间有8个研究报道了骨折愈合时间情况[6，9-11，14-16，18]，其中微创经皮接骨板内固定组236例，传统切开复位内固定组266例。异质性分析显示，各研究无明显异质性(I2=88%)，故采用随机效应模型分析，Meta分析结果见图5，2种手术骨折愈合时间差异有显著性意义[OR=-0.71，95%CI(-1.26，-0.16)，P=0.01]，微创经皮接骨板内固定组骨折愈合时间短于传统切开复位内固定组。 2.2.5 肱骨头坏死有6个研究报道了术后肱骨头坏死，其中微创经皮接骨板内固定组170例[5，8-9，14-15，19]，传统切开复位内固定组210例。异质性分析显示各研究无明显异质性(I2=40%)，故采用固定效应模型分析，Meta分析结果见图6，2种手术后肱骨头坏死情况差异有显著性意义[OR= -0.07，95%CI(-0.11，-0.02)，P=0.005]，微创经皮接骨板内固定组肱骨头坏死发生率少于传统切开复位内固定组。 2.2.6 术后3个月Constant评分情况有6个研究报道了术后3个月Constant评分情况[5-6，9-10，12，16]，其中微创经皮接骨板内固定组198例，传统切开复位内固定组247例。异质性分析显示，各研究无明显异质性(I2=0%)，故采用固定效应模型分析，Meta分析结果见图7，2种手术后3个月Constant评分差异有显著性意义[OR=5.20，95%CI(4.12，6.28)，P < 0.000 01]，微创经皮接骨板内固定组术后3个月Constant评分高于传统切开复位内固定组。 2.2.7 术后12个月Constant评分情况有14个研究报道了术后12个月Constant评分情况[5-6，9-12，16，18]，其中微创经皮接骨板内固定组559例，传统切开复位内固定组612例。异质性分析显示，各研究异质性明显(I2=75%)，故采用随机效应模型分析，Meta分析结果见图8，2种手术后12个月Constant评分差异无显著性意义[OR=0.03，95%CI(-0.21，0.28)，P=0.80]。 2.2.8 术后并发症情况有7个研究报道了术后并发症情况[5-6，11-12，14-15，19]，其中微创经皮接骨板内固定组207例，传统切开复位内固定组258例。异质性分析显示，各研究无明显异质性(I2=28%)，故采用固定模型分析，Meta分析结果见图9，2种手术后并发症发生率差异无显著性意义[OR=0.59，95%CI(0.32，1.07)，P=0.08]。"

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