假体置换与切开复位内固定治疗MasonⅢ型桡骨头骨折的Meta分析

Treatment for Mason type Ⅲ radial head fracture with open reduction and internal fixation versus prosthetic replacement:A Meta analysis

背景:MasonⅢ型桡骨头骨折是桡骨头的粉碎性骨折,治疗比较困难,现在主要治疗方法是切开复位内固定或者人工假体置换,但是这两种治疗方法的疗效还存有一定争议。目的:应用Meta分析评价人工假体置换与切开复位内固定治疗MasonⅢ型桡骨头骨折的疗效,为临床治疗MasonⅢ型桡骨头骨折提供依据。方法:计算机检索CENTRAL(TheCochraneLibrary,1993/2011)、Medline(1980/2011)、BiomedCentral(1997/2011)、Ovid(1993/2011)和中国期刊全文数据库(CNKI,1994/2011)、万方数据库(1993/2011)。搜集MasonⅢ型桡骨头骨折假体置换和切开复位内固定两种治疗方法的对照研究报告并加以比较。用RevMan5.0统计学软件进行异质性分析及Meta分析。结果与结论:共纳入1篇随机对照试验,3篇临床对照试验,总计109例,其中假体置换组55例,切开复位内固定组54例。①疗效:根据Broberg和Morrey肘关节功能评分标准,假体置换组优良率优于切开复位内固定组,差异有显著性意义(P=0.001)。②并发症:切开复位内固定组并发症发生率高于假体置换组,差异有显著性意义(P=0.001)。通过疗效及并发症评价证实人工假体置换治疗MasonⅢ型桡骨头骨折优于切开复位内固定,结果满意,但是在肘关节活动度方面未见明显统计学差异,鉴于纳入文献较少且质量不高,最终的结论需要设计更加严谨的随机对照研究及更多的病例数加以证实。

BACKGROUND： Mason type Ⅲ radial head fracture is the comminuted fracture of the radial head, the treatment is more difficult. Prosthetic replacement versus open reduction and internal fixation are the two main modalities, but there is a certain controversy on the efficacy of these two treatment modalities. OBJECTIVE： To verify the effectiveness of prosthetic replacement versus open reduction and internal fixation for the treatment of Mason type Ⅲ radial head fracture through a Meta analysis which provides evidence for the clinical treatment of Mason type Ⅲ radial head fracture. METHODS： We searched CENTRAL （The Cochrane Library, 1993-2011 ）, Medline （1980-2011 ）, Biomed Central （1997-2011 ）, Ovid （1993-2011 ）, China Academic Journal （CNKI, 1994-2011 ） and Wanfang database （1993-2011 ）. The reports on the treatment of Mason type Ⅲ radial head fracture by prosthetic replacement and open reduction and internal fixation were collected and the effect of these two modalities was compared through Meta analysis. RevMan 5.0 statistical software was used to perform the heterogeneity analysis and Meta analysis. RESULTS AND CONCLUSION： There were 3 controlled clinical trails and 1 randomized controlled trial, a total of 109 cases, of which 55 patients in prosthetic replacement group and 54 patients in open reduction and internal fixation group. （1）Effectiveness： according to the Broberg and Morrey elbow score, prosthetic replacement group was superior to open reduction and internal fixation group in good rate, the difference was statistically significant （P= 0.001）. （2）Complications： the incidence of complications in the open reduction and internal fixation group was higher than that in the prosthetic replacement group, and the difference was statistically significant （P=0.001）. By evaluating the efficacy and complications of prosthetic replacement versus open reduction and internal fixation for the treatment of Mason type Ⅲ radial heads, prosthetic replacement is superior to open reduction and internal fixation, with satisfactory results. But there was no significant difference of the elbow activity. In view of the less literatures and the poor quality, it needs to design a more rigorous randomized controlled trial and more case number to confirm the final conclusion.