| Objective:Meta-analysis was used to evaluate and compare the effects of intramedullary nailing(IMN)and plate fixation(PLT)in treating the humeral shaft fractures in adults,so as to provide a reference for the choice of therapeutic scheme.Methods:According to the recommended method of Cochrane collaboration network to carry on the meta-analysis.Pub Med databases、Cochran Central databases、Embase databases and Google scholar were searched by computer,Time span was from January 1990 to October 2016.All of the clinical randomized controlled trials of intramedullary nailing(IMN)and plate fixation(PLT)in treating the humeral shaft fractures in adults were collected.Using the bias risk assessment tool provided by the Cochrane collaboration network to assess the methodological quality of the included studies.Merging analysis was used based upon systematic review approach after the date extraction is completed.Heterogeneity was assessed by use of the standard chi-squared test and the I2.Using Begg funnel plots and Egger bias test to assess publication bias,which were finished by using STATA 12.0 software.Using GRADE pro 3.6 software to evaluate the quality of the evidences.Results:After screening,20 clinical randomized controlled trials which meet the criteria were included in this study.A total of 722 patients,of which 347 cases of IMN group,375 cases of PLT group.The results showed that there were significant differences in reducing the incidence of iatrogenic fracture(RR=4.35,95% CI:1.38 — 13.73;P=0.01),shoulder impingement(RR=7.44,95% CI:3.32 — 16.65;P<0.00001),reoperation(RR=2.12,95% CI:1.36 — 3.30;P=0.0009),restriction of shoulder range of movement(RR=10.74,95% CI:2.04 — 56.41;P=0.005),shoulder stiffness(RR=3.19,95% CI:1.11 — 9.17;P=0.03),adhesive capsulitis of shoulder(RR=3.33,95% CI:1.12 — 9.89;P=0.03)and shorten the mean intraoperative radiation exposure time(SMD=1.47,95% CI:0.34 — 2.59;P=0.01)and increasing the mean Constant score(SMD=-0.68,95% CI:-1.12—-3.30;P=0.002),mean Mayo score(SMD=-1.01,95% CI:-1.62 —-0.40;P=0.001),PLT better than IMN.But in reducing the mean union time(SMD=-0.53,95% CI :-0.77 —-0.30;P=0.0001),mean intraoperative blood loss(SMD=-1.75,95% CI:-3.36 —-0.14;P=0.03),IMN better than PLT.Besides,there were no significant differences in reducing the incidence of fracture delayed union(RR=1.82,95% CI:0.64 — 5.17;P=0.26)or fracture union(RR=1.31,95% CI:0.77 — 2.23;P=0.32),iatrogenic radial nerve palsy(RR=0.73,95% CI:0.42 — 1.26;P=0.25),implant failure(RR=1.21,95% CI:0.48 —3.05;P=0.69)and reducing the mean operation time(SMD=-0.46,95% CI:-1.07 — 0.77;P=0.46),mean hospital stay(SMD=-1.15,95% CI:-2.41 — 0.10;P=0.07),mean interval between admissions to surgery(SMD=-3.85,95% CI:-8.34 — 0.64;P=0.09)and increasing the mean ASES score(SMD=-0.36,95% CI:-0.76 — 0.05;P=0.08),mean UCLA score(SMD=-0.04,95% CI:-0.66 — 0.58;P=0.08),mean C-M score(SMD=-0.51,95% CI:-0.14 — 0.12;P=0.11)between two interventions.Begg funnel plots and Egger’s bias test show that there were no significant publication bias.The GRADE system evidence quality results: 6 moderate quality evidence,15 low quality evidences and 1 very low quality evidence.Conclusion:Intramedullary nail fixation and plate fixation both have advantages in the treatment of adult humeral shaft fractures,but intramedullary nails are more likely to cause more clinical complications.Therefore,it is better to treat adult humeral shaft fractures with plate fixation.However,the cumulative evidence remains inconclusive.Therefore,more high-quality prospective randomized controlled trials will need to be included to further validate this conclusion or to draw a new conclusion. |
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