Deltoid-split approach versus deltopectoral approach in displaced proximal humeral fracture: A meta-analysis

doi:10.3877/cma.j.issn.2096-0263.2018.06.009

Abstract

Abstract:

Objective

To compare the efficacy and safety of Deltoid-split approach versus Deltopectoral approach in the treatment of displaced proximal humeral fracture.

Methods

Articles compared two surgical approaches published in Embase, Pubmed, CNKI, Chinese Biomedical Database, Wanfang Data, Cochrane Library and other well-known databases were retrieved from January 2006 to April 2018. Methodological quality of the trials was critically assessed, and relevant data were extracted. Statistical software Revman 5.3 was used for data-analysis.

Results

A total of 789 patients in 10 controlled studies were included in the meta-analysis. Results showed statistical significance were found in the operation time (95% CI: -26.56-9.77, P<0.00001), intraoperative blood loss (95% CI: -73.79--19.54, P<0.00001], length of hospital stay (95% CI: -1.35--0.60, P<0.00001), constant score 3 month after operation (95% CI: 4.38-6.92, P<0.00001), Activity of daily living (ADL) 6 month and 12 month after operation (95% CI: 0.27-2.02, P=0.01) between two approaches. The constant score at 6 months (95% CI: -1.66-6.74, P=0.24) and 12 months after operation (95% CI: -7.01-7.73, P=0.92), 12 months postoperative ADL (95% CI: -0.18-1.49, P=0.12), DASH (95% CI: -4.91-2.47, P=0.52, complications (95% CI: 0.55-1.34, P=0.51) were not statistically significant.

Conclusions

The Deltoid-split approach is superior to the deltopectoral approach in the treatment of displaced proximal humeral fracture regards to the operation time, blood loss, length of hospital stay, union time. But there is not enough evidence on the incidence of complications, long term limb function and other aspects.

Key words: Humeral fractures, Meta-analysis, Surgical approach

Taoyu Chen, Shaowei Wang, Xiaojian Wang, Pengfeng Han, Pengcui Li, Xiaochun Wei. Deltoid-split approach versus deltopectoral approach in displaced proximal humeral fracture: A meta-analysis[J]. Chinese Journal of Geriatric Orthopaedics and Rehabilitation(Electronic Edition), 2018, 04(06): 360-368.

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Figures/Tables 7

References 22

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作者	研究设计	年份	手术入路	例数	年龄（岁，±s）	国家	纳入分析项目	随访（月）
Lin等^[9]	回顾性	2014	DS	43	63±14	中国	ABCGHJ	12
Lin等^[9]	回顾性	2014	DP	43	61±12	中国	ABCGHJ	12
R?derer等^[10]	前瞻性	2011	DS	46	66.1±12.2	瑞士	ABCJ	9.5
R?derer等^[10]	前瞻性	2011	DP	42	66.1±12.2	瑞士	ABCJ	9.5
Hepp等^.[11]	回顾性	2008	DS	39	65±11.6	德国	EFGHIJ	12
Hepp等^.[11]	回顾性	2008	DP	44	65±11.6	德国	EFGHIJ	12
Liu等^[12]	回顾性	2015	DS	39	60.2±14.4	中国	ABDEFJI	24
Liu等^[12]	回顾性	2015	DP	52	61.7±13.7	中国	ABDEFJI	24
Wu等^[13]	回顾性	2011	DS	28	58.6±11.0	中国	ABCFIJ	32
Wu等^[13]	回顾性	2011	DP	32	57.7±20.7	中国	ABCFIJ	32
Buecking等^[14]	前瞻性	2014	DS	60	69±1.5	德国	ACDEFGH	12
Buecking等^[14]	前瞻性	2014	DP	60	67±2	德国	J	12
张耀武等^[15]	回顾性	2018	DS	64	71.3±9.1	中国	ABCDJ	6
张耀武等^[15]	回顾性	2018	DP	64	73.7±6.3	中国	ABCDJ	6
侯建伟等^[16]	回顾性	2017	DS	20	62.3±7.6	中国	ABD	16
侯建伟等^[16]	回顾性	2017	DP	20	64.8±8.6	中国	ABD	16
陈福扬等^[17]	回顾性	2017	DS	26	48.2±12.1	中国	ABJ	12
陈福扬等^[17]	回顾性	2017	DP	20	51.3±12.8	中国	ABJ	12
范亚杰等^[18]	回顾性	2017	DS	23	65.5±2.5	中国	ABCJ	12
范亚杰等^[18]	回顾性	2017	DP	24	64.6±2.4	中国	ABCJ	12

作者	研究设计	年份	手术入路	例数	年龄（岁，±s）	国家	纳入分析项目	随访（月）
Lin等^[9]	回顾性	2014	DS	43	63±14	中国	ABCGHJ	12
Lin等^[9]	回顾性	2014	DP	43	61±12	中国	ABCGHJ	12
R?derer等^[10]	前瞻性	2011	DS	46	66.1±12.2	瑞士	ABCJ	9.5
R?derer等^[10]	前瞻性	2011	DP	42	66.1±12.2	瑞士	ABCJ	9.5
Hepp等^.[11]	回顾性	2008	DS	39	65±11.6	德国	EFGHIJ	12
Hepp等^.[11]	回顾性	2008	DP	44	65±11.6	德国	EFGHIJ	12
Liu等^[12]	回顾性	2015	DS	39	60.2±14.4	中国	ABDEFJI	24
Liu等^[12]	回顾性	2015	DP	52	61.7±13.7	中国	ABDEFJI	24
Wu等^[13]	回顾性	2011	DS	28	58.6±11.0	中国	ABCFIJ	32
Wu等^[13]	回顾性	2011	DP	32	57.7±20.7	中国	ABCFIJ	32
Buecking等^[14]	前瞻性	2014	DS	60	69±1.5	德国	ACDEFGH	12
Buecking等^[14]	前瞻性	2014	DP	60	67±2	德国	J	12
张耀武等^[15]	回顾性	2018	DS	64	71.3±9.1	中国	ABCDJ	6
张耀武等^[15]	回顾性	2018	DP	64	73.7±6.3	中国	ABCDJ	6
侯建伟等^[16]	回顾性	2017	DS	20	62.3±7.6	中国	ABD	16
侯建伟等^[16]	回顾性	2017	DP	20	64.8±8.6	中国	ABD	16
陈福扬等^[17]	回顾性	2017	DS	26	48.2±12.1	中国	ABJ	12
陈福扬等^[17]	回顾性	2017	DP	20	51.3±12.8	中国	ABJ	12
范亚杰等^[18]	回顾性	2017	DS	23	65.5±2.5	中国	ABCJ	12
范亚杰等^[18]	回顾性	2017	DP	24	64.6±2.4	中国	ABCJ	12

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