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Operative vs non-operative management of displaced proximal humeral fractures in the elderly: A systematic review and meta-analysis of randomized controlled trials

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世界骨科杂志：英文版 2015年第10期6卷 838-846页

作者： Santa Rabi Nathan Evaniew sheila a sprague Mohit Bhandari Gerard P Slobogean Department of Clinical Epidemiology and Biostatistics Mc Master University Division of Orthopedics Department of SurgeryMc Master University Department of Orthopaedics University of Maryland School of MedicineR Adams Cowley Shock Trauma Center

AIM: To perform a systematic review and meta-analysis comparing operative vs non-operative treatment of displaced proximal humerus fractures in elderly ***: A systematic literature search was performed using EMBASE and MEDLINE through the OVID interface,CINAHL,the Cochrane Central Register of Controlled Trials(CENTRAL),Proquest,Web of Science,SAE digital library,and Transportation Research Board's TRID *** of conference proceedings were also *** available randomized controlled trials comparing operative vs non-operative management of displaced three- and four-part proximal humerus fractures in elderly patients were *** primary outcomes measures included physical function,pain,health related quality of life,mortality,and the re-operation ***: Six randomized controlled trials(n = 287) were *** was no statistically significant difference in function(MD = 1.72,95%CI:-2.90-6.34,P = 0.47),as measured by the Constant score,between the operative and the non-operative treatment *** was no statistically significance difference insecondary outcomes of health related quality of life(standardized MD = 0.27,95%CI:-0.05-0.59,P = 0.09),and mortality(relative risk 1.29,95%CI: 0.50-3.35,P = 0.60).Operative treatment had a statistically significant higher re-operation rate(relative risk 4.09,95%CI: 1.50-11.15,P = 0.006),and statistically significant decreased pain(MD = 1.26,95%CI: 0.02-2.49,P = 0.05).CONCLUSION: There is moderate quality evidence to suggest that there is no difference in functional outcomes between the two *** high quality randomized controlled trials are required to determine if certain subgroup populations benefit from surgical management.

关键词： Proximal humerus fracture Outcomes Operative treatment Non-operative treatment Metaanalysis

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