Locking Plate Versus Hemiarthroplasty For The Treatment Of Proximal Humerus Three Or Four Parts Fracture:A Meta-analysis

Objective Systematic evaluation of Locking Plate versus Hemiarthroplasty for the treatment of proximal humerus three or four part fracture clinical curative effect。Methods By computer retrieval PubMed(January,1989 to December,2014)and Embas( January, 1989 to December, 2014), CNKI( January, 1995 to December,2014), through manual retrieval the Chinese journal of orthopedic, the Chinese journal of surgical,Chinese Journal of Trauma during January,(2000 to December, 2014) about locking plate versus Hemiarthroplasty in the treatment of proximal humeral fractures, First, to make strict inclusion and exclusion criteria,Then the NRCT according to MINORS rating scale score,Included RCT according to the Jadad scale score, using the Cochrane collaboration of Revman5.0 software for statistical analysis, the expression of continuous variables using the weighted mean difference(WMD) or standard mean difference(SMD) and 95% confidence intervals(95%CI), two categorical data using RR(relative risk) or OR(odds ratio) and 95% confidence interval(95%CI) as the evaluation indicator,According to the size of the heterogeneity choose a random effect model or fixed effect model,According to funnel figure judge literature bias.Results Patients treated with locking plate in the constant score(P = 0.0004) is better than Hemiarthroplasty, Patients treated with Hemiarthroplasty in operative time(P<0.001),complications(P= 0.006) and revision(P <0.001) and VAS score(P= 0.02)are better than the patients who treated with locking plate.Two operation methods in surgical blood loss(P = 0.56), ASES score(P = 0.36) and postoperative fine rate(P =0.99) have no statistical differences.Conclusions 1 Both surgical procedures are effective means for proximal humerus three, four-part fractures. 2 For young patients with postoperative shoulder range of activities that require high,we recommended locking plate fixation.3 For the elderly or poor bone to relieve the pain of shoulder function in patients with less demanding,Hemiarthroplasty is a good choice.