曹春风;马坤龙;栾和旭;王群波;卢旻鹏;邱皓;程瑜;

• 1:重庆医科大学附属永川医院
• 2:重庆医科大学附属大学城医院

摘要(Abstract)：

[目的]利用Meta分析研究比较钢板内固定与髓内钉固定(intramedullary nailing,IMN)治疗肱骨干骨折的临床疗效。[方法]计算机检索Cochrane骨科组,关节与肌肉创伤组,Cochrane图书馆,MEDLINE数据库,EMBASE数据库,OVID数据库以及谷歌学术2014年10月31日之前所有已发表的关于钢板固定与髓内钉固定治疗肱骨干骨折的文献,并评价纳入研究的方法学质量。文献评价以及数据提取由2名研究员独立完成。[结果]共纳入10篇完全随机对照试验(RCTs)文献和3篇半随机对照试验(quasi-RCTs)文章,共544例患者。通过与髓内钉固定比较,研究结果显示钢板内固定治疗组的再手术率、骨折延迟愈合、肩关节活动受限明显较低,但术后总体感染率高于髓内钉组。另外,两种手术方式的骨折不愈合、深部感染、桡神经损伤、医源性骨折及内固定失败发生情况差异并无明显统计学意义。[结论]结果显示通过钢板内固定手术治疗肱骨干骨折的疗效优于髓内钉内固定。但由于纳入的新文献质量并不高,有待更高质量的完全随机对照研究来进一步证实这个结果。

关键词(KeyWords)： 肱骨骨折;骨折固定术;髓内;钢板固定;疗效评价

Abstract:

Keywords:

基金项目(Foundation):

作者(Author): 曹春风;马坤龙;栾和旭;王群波;卢旻鹏;邱皓;程瑜;

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参考文献(References)：

• [1]Mahabier KC,Vogels LM,Punt BJ,et al.Humeral shaft fractures:retrospective results of non-operative and operative treatment of 186patients[J].Injury,2013,44(4):427-430.
• [2]Ekholm R,Adami J,Tidermark J,et al.Fractures of the shaft of the humerus.An epidemiological study of 401 fractures[J].J Bone Joint Surg Br,2006,88(11):1469-1473.
• [3]赵志明,舒衡生,万春友,等.可膨胀自锁型髓内钉治疗肱骨干骨折[J].中国矫形外科杂志,2009,17(20):1534-1536.
• [4]Heineman DJ,Poolman RW,Nork SE,et al.Plate fixation or intramedullary fixation of humeral shaft fractures[J].Acta Orthop,2010,81(2):216-223.
• [5]Hwang YS,Kim KY,Kim HC,et al.Polarus intramedullary nail for proximal humeral and humeral shaft fractures in elderly patients with osteoporosis[J].J Kor Frac Soci,2013,26(1):14.
• [6]Livani B,Belangero W,Medina G,et al.Anterior plating as a surgical alternative in the treatment of humeral shaft non-union[J].Int Orthop,2010,34(7):1025-1031.
• [7]Kumar V,Rathinam M.Fractures of the shaft of humerus[J].Orthopaedics and Trauma,2013,27(6):393-402.
• [8]Baltov A,Mihail R,Dian E.Complications after interlocking intramedullary nailing of humeral shaft fractures[J].Injury,2014,45(Suppl 1):S9-S15.
• [9]Kurup H,Hossain M,Andrew JG.Dynamic compression plating versus locked intramedullary nailing for humeral shaft fractures in adults[J].Cochrane Database Syst Rev,2011(6):CD005959.
• [10]Zhang W,Nuki G,Moskowitz RW,et al.OARSI recommendations for the management of hip and knee osteoarthritis:partⅢ:changes in evidence following systematic cumulative update of research published through January 2009[J].Osteoarthritis Cartilage,2010,18(4):476-499.
• [11]Jadad AR,Moore RA,Carroll D,et al.Assessing the quality of reports of randomized clinical trials:is blinding necessary[J].Control Clin Trials,1996,17(1):1-12.
• [12]Mc Cormack RG,Brien D,Buckley RE,et al.Fixation of fractures of the shaft of the humerus by dynamic compression plate or intramedullary nail.A prospective,randomised trial[J].J Bone Joint Surg Br,2000,82(3):336-339.
• [13]Singisetti K,Ambedkar M.Nailing versus plating in humerus shaft fractures:a prospective comparative study[J].Int Orthop,2010,34(4):571-576.
• [14]Liu GD,Zhang QG,Ou S,et al.Meta-analysis of the outcomes of intramedullary nailing and plate fixation of humeral shaft fractures[J].Int J Surg,2013,11(9):864-868.
• [15]Wang X,Chen Z,Shao Y,et al.A meta-analysis of plate fixation versus intramedullary nailing for humeral shaft fractures[J].J Orthop Sci,2013,18(3):388-397.
• [16]Steffner RJ,Lee MA.Emerging concepts in upper extremity trauma:humeral shaft fractures[J].Orthop Clin North Am,2013,44(1):21-33.
• [17]Cheng HR,Lin J.Prospective randomized comparative study of antegrade and retrograde locked nailing for middle humeral shaft fracture[J].J Trauma,2008,65(1):94-102.
• [18]Ouyang H,Xiong J,Xiang P,et al.Plate versus intramedullary nail fixation in the treatment of humeral shaft fractures:an updated meta-analysis[J].J Shoulder Elbow Surg,2013,22(3):387-395.
• [19]Shao YC,Harwood P,Grotz MR,et al.Radial nerve palsy associated with fractures of the shaft of the humerus:a systematic review[J].J Bone Joint Surg Br,2005,87(12):1647-1652.
• [20]Huttunen TT,Kannus P,Lepola V,et al.Surgical treatment of humeral-shaft fractures:a register-based study in Finland between 1987and 2009[J].Injury,2012,43(10):1704-1708.