锁定钢板内固定与半肩关节置换治疗老年人粉碎性肱骨近端骨折疗效的Meta分析

目的 通过对相关文献进行meta分析，了解锁定钢板内固定（LPF）与半肩关节置换（HAP）治疗老年人粉碎性肱骨近端骨折疗效等方面的差异，评价2种手术方法的优劣。方法 计算机检索Pubmed、Cochrane library等外文数据库及万方、维普等中文数据库自2005年1月至2016年4月期间发表的有关LPF与HAP治疗老年人粉碎性肱骨近端骨折的前瞻性随机对照研究，评价纳入文献的质量并提取数据，采用Rev Man 5.3软件进行meta分析。结果 纳入9篇符合标准的文献，共550例患者，其中LPF组274例，HAP组276例，meta分析结果如下：在CMS评分、ASES评分的比较上，LPF组优于HAP组，在手术时间、术中出血量、术后引流量及住院时间的比较上，HAP组优于LPF组，LPF组与HAP组的术后Neer评分优良率、术后并发症发生率的差异无统计学意义（P<0.05）。结论 LPF与HAP治疗老年人粉碎性肱骨近端骨折各有利弊。若患者对术后肩关节功能要求较高，可选择LPF；若患者骨质疏松严重，身体条件不佳且功能要求不是太高，HAP是一种比较好的选择。

Meta-analysis on efficacy of locking plate fixation versus hemiarthroplasty in treatment of comminuted proximal humeral fractures in elderly people

Objective To probe into the difference between locking plate fixation and hemiarthroplasty in the treatment of comminuted proximal humeral fractures in elderly people, and evaluate their efficacy by meta-analysis.Methods Prospective randomized controlled studies associated with proximal humeral locking plate and hemiarthroplasty between January 2005 and April 2016 in such foreign databases as Pubmed, the Cochrane library,etc and such Chinese databases as Wan Fang database, VIP,etc were included. The quality of the articles was assessed and the valid data was extracted. The Rev Man 5.3 was used for meta-analysis.Results A total of 550 patients from 9 trials were included in this meta-analysis (274 patients treated with locking plate fixation and 276 patients with hemiarthroplasty). The results showed that patients with locking plate fixation had better CMS and ASES than those treated with hemiarthroplasty. But the patients with hemiarthroplasty had better outcome in the mean operation time, mean loss blood, mean postoperative drainage and the mean hospital stay. There was no significant difference in the Neer rated excellent rate and the rate of complications.Conclusion Both the locking plate fixation and hemiarthroplasty have advantages and disadvantages in treating comminuted proximal humeral fractures in elderly people. If the patients expect better functional outcomes, the locking plate fixation is preferred, while the hemiarthroplasty constitutes an excellent alternative for patients with severe osteoporosis, poor health and low expectation for functional outcomes.