Meta Analysis Of Intramedullary Nail.and Plate Fixation In The Treatment Of Humeral Shaft Fracture

Objective : To evaluate the efficacy and advantages of IMN and PF in the treatment of humerus shaft fractures.through the method of meta-analysis.Methods: The literature search was conducted using the PubMed ? Medline ? EMbase ?Cochrane Library?Web of Science?China National Knowledge Infrastructure(CNKI)?China Biology Medicine,(CBM)?WanFang and China vip academic data(VIP),The retrieval period was from January 1995 to December 2019.All the randomized controlled trials(RCTs)and Quasi-randomized controlled trials(Q-RCTs)that met the inclusion criteria were collected,and the collected literatures were screened by 2 researchers independently,and the eligible studies were screened strictly according to the inclusion and exclusion criteria set out in this study,and then the data were extracted and quality evaluated.Finally,Meta analysis was performed on the included RCTs and q-rcts: the Review Manager 5.3 software was used for data synthesis,and the Q test was used for heterogeneity analysis,if P < 0.1,I2 > 50%,the random effects model is adopted,If P ? 0.1,I2 ? 50%,use the fixed effects model.For continuous variables are described by mean difference(MD)and its 95%CI,dichotomous variables,risk ratio(RR)and 95% confidence interval(95%CI)were used for evaluation;Results: A total of 17 studies(14 RCTs and 3 Q-RCTs)were included in this study,A total of 1053 patients were involved,including 528(50.14%)in the IMN group and 525(49.86%)in the PF group.First,among the four main clinical outcome indicators,The infection rate of IMN group [RR= 0.40,95%CI = 0.20-0.79,P =0.008] and the incidence of iatrogenic radial nerve injury [RR= 0.60,95%CI = 0.36-0.97,P =0.04] were lower than that of PF group;For the two outcome indicators of nonunion and delayed union,Meta analysis showed no statistical difference between the two groups(P>0.05).Second,among the five secondary clinical outcome indicators,PF group hospitalization time [RR=-2.60,95%CI=-4.90~-0.30,P =0.03],surgery time [RR=-21.74,95%CI=-39.55~-3.92,P =0.02],intraoperative blood loss(RR = 72.97,95% CI = 95.44 ~ 50.51,P < 0.01] and healing time[RR=-2.25,95%CI=-2.59~-1.91,P <0.01] was higher than that of IMN group.There was no statistical difference in the scores of ASES between the two groups(P>0.05).Conclusions: This study proved that IMN had advantages over PF in infection rate,iatrogenicradial nerve injury,length of hospital stay,operation time,intraoperative blood loss and healing time.There was no significant difference between the two groups in the three outcome indicators of ASES score,non-healing and delayed healing.In this study,few references were included and the sample size was insufficient,so there may be some differences between the research conclusion and the clinical facts.Therefore,for the evaluation of the efficacy and advantages and disadvantages of IMN and PF in the treatment of humerus shaft fracture,large-sample and high-quality studies are needed in the future.