A Meta-analysis Of The Efficacy Of Cannulated Screw Versus Bone Plate Internal Fixation In The Treatment Of Humeral Tuberosity Fracture

Objective:Meta-analysis of in the treatment of greater tuberosity fracture of humerus with cannulated screw versus bone plate.Methods:Use Cochrane Library,EMBASE,PubMed,Wanfang Data Database,CNKI,VIP and CBM to search and collect the clinical trial literature of greater tuberosity fracture of humerus with cannulated screw and bone plate.Two professional evaluators performed independent literature screening,quality evaluation,and data extraction based on the inclusion and exclusion criteria.Meta-analysis of collected data using RevMan5.2 software.Results:After screening,a total of 5 clinical randomized controlled trials and 12 cohort studies were selected for meta-analysis.A total of 1068 patients were included,including 559 patients with cannulated screw internal fixation and 509 patients with bone plate internal fixation.The Meta analysis showed that the operation time of cannulated screw for the treatment of large humeral tubercle fractures was shorter than that of bone plates [MD =-23.03,95% CI(-29.69,-16.36),P <0.0001],and less intraoperative bleeding [ MD =-36.39,95% CI(-53.73,-19.04),P <0.0001],shorter hospital stay [MD =-1.86,95% CI(-3.39,-0.64),P = 0.003],fracture healing is more Fast [MD =-2.23,95% CI(-4.27,-0.18),P = 0.03],lower incidence of postoperative infection [OR = 0.17,95% CI(0.03,0.97),P = 0.05],internal The fixed failure rate was higher [OR = 3.56,95% CI(1.29,9.81),P = 0.01],and the differences were statistically significant.Postoperative VAS pain score [MD =-1.34,95% CI(-2.77,0.09),P = 0.07],ASES shoulder joint score [MD = 0.26,95% CI(-6.43,6.96),P = 0.94],Constant shoulder score [MD =-4.05,95% CI(-8.51,0.42),P = 0.08],Constant shoulder score excellent rate [MD =-1.30,95% CI(0.46,3.72),P = 0.62],Neer shoulder joint score excellent rate [OR = 2.04,95% CI(0.97,4.28),P = 0.06],total complication rate [OR = 1.50,95% CI(0.42,5.35),P = 0.53],the incidence of postoperative pain [OR = 0.74,95% CI(0.04,14.49),P = 0.84] and the incidence of postoperative acromion syndrome [OR = 0.88,95% CI(0.02,40.63),P = 0.95] None of the differences were statistically significant.Conclusion:Using cannulated screw to treat greater tuberosity fracture of humerus compared with bone plate can lead to faster operation time,less intraoperative blood loss,shorter hospital stay,lower incidence of postoperative infection and better promotion of fracture healing.Relatively speaking,the greater tuberosity fracture of humerus with cannulated screw is more advantageous.