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- 胡稷杰副主任医师 博士
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医院:
南方医科大学南方医院
科室:
创伤骨科
- 肱骨近端锁定钢板/肱骨近端内锁定系统与其他内固定治疗成人肱骨近端骨折的系统评价
- 作者:胡稷杰|发布时间:2012-07-29|浏览量:501次
肱骨近端锁定钢板或肱骨近端内锁定系统与不同内固定
治疗成人肱骨近端骨折的系统评价
胡稷杰 余斌 魏宽海 任高宏 金丹 王钢南方医科大学南方医院创伤骨科胡稷杰
南方医科大学南方医院创伤骨科
【摘要】 目的 对采用肱骨近端锁定钢板或肱骨近端内锁定系统与其他内固定治疗肱骨近端骨折的临床疗效进行系统评价。方法 检索Ovid Medline和PubMed、Embase、Cochrane Central Register of Controlled Trials和中国生物医学文献数据库等,搜集全部有关LPHP/PHILOS治疗肱骨近端骨折的各种对照研究,进行系统评价。结果 共纳入18个非随机对照试验,所有18个研究均为C级。资料分析结果显示:LPHP/PHILOS的异位骨化几率与PHN组无统计学差异。LPHP/PHILOS的Neer评分优良率、肩关节活动受限发生率与经皮内固定组无显著性差异;而LPHP/PHILOS的Neer评分优良率及螺钉松动发生率优于常规钢板组;传统钢板组与LPHP/PHILOS组的术后肱骨头坏死率及肩峰撞击率无显著性差异。CHS组肱骨头坏死率低于LPHP/PHILOS组。结论 目前尚不能肯定LPHP/PHILOS优于各类传统内固定。不能盲目扩大LPHP/PHILOS的临床适应症。临床治疗方案要结合患者的病情甚至经济情况综合考虑。
关键词: 肱骨近端骨折;骨折固定术;对照试验;系统评价;锁定钢板
Operative Treatment of Proximal Humerus Fractures in adults with LPHP/PHILOS versus other internal fixations:a Systematic Review
Hu Ji-jie, Jin dan, Wei-kuan hai, et al.
Department of Orthopaedics and Traumatology, Nanfang Hospital, Nanfang Medical University, Guangzhou, 510515, China
[Abstract]:Objective: To evaluate and compare the efficacy of Locking Proximal humerus plate/ Proximal Humeral Internal Locking System (LPHP/PHILOS) versus other internal fixations for the treatment of Proximal Humeral Fractures in adults. including LPHP/PHILOS versus proximal humeral nail/ non-locking plates / percutaneous internal fixations/compression hollow screw. Methods:. According to Cochrane systematic review, Cochrane library, Medline, Embase,CNKI,VIP,and Chinese Biomedical Database were retrieved for Randomized Controlled Trials(RCTs), Quasi Randomized Controlled Trials (Quasi-RCTs) and Non-Randomized Controlled Trials(Non-RCTs) comparing relevant interventions for the treatment of proximal humeral fractures with LPHP/PHILOS versus other internal fixations. Results: 18 Non-RCTs were included in this systematic review. For methodology quality of trail, they were all C scale. Data analysis showed that the rate of heterotopic ossification showed no statistic differences compared with PHN. The excellent and good rate of Neer and shoulder activity limitation rate showed no statistic difference between LPHP/PHILOS and Percutaneous internal fixations; The excellent and good rate of Neer in LPHP/PHILOS was higher, while the rate of loose screws was lower compared with Non-locking plates in the rate, however, The humeral head avascular necrosis and subacromial impingement showed no statistic differences in the rate between LPHP/PHILOS and Non-locking plates. The rate of humeral head avascular necrosis was lower in CHS than in LPHP/PHILOS.Conclusions:. The current literature offers no robust evidence to support the use of LPHP/PHILOS over other internal fixation for PHFs. It is inadequate to use LPHP/PHILOS in every type of PHFs. The patients’state of illness, economic status and demands should also be considered by the surgeons to provide the best treatment and produce the best outcome.
[Key words]: Proximal Humeral Fractures; Internal fixation, Controlled trials; Systematic review; Locking plate