假体置换和切开复位内固定术治疗成人桡骨头Mason Ⅲ型骨折效果的系统评价

Prosthetic Replacement and Open Reduction and Internal Fixation in Treatment of Adults with Mason Type ⅢRadial Head Fracture: A System Assessment

目的系统评价假体置换与切开复位内固定术治疗成人桡骨头MasonⅢ型骨折的效果。方法计算机检索PubMed、MEDLINE、EBM、中国生物医学文献数据库、万方数据知识服务平台和中国学术期刊网,手工检索《中华外科杂志》等中文主要外科杂志。收集假体置换与切开复位内固定术治疗成人桡骨头MasonⅢ型骨折的前瞻性或回顾性对比研究进行Meta分析。结果共纳入6个临床研究,其中2个前瞻性随机对照研究(RCT),4个回顾性对照观察研究(CCT)。功能评价及并发症方面假体置换要显著优于切开复位内固定,术后异位骨化、肘关节活动范围受限等方面均无显著性差异。结论与切开复位内固定术相比,假体置换术治疗成人MasonⅢ型桡骨头骨折,术后肘关节功能优,并发症发生率少。目前还缺少对假体置换中长期的随访结果,研究结果的可靠性也需要多中心、大样本长期随访的RCT试验证实。

Objective To compare the effect between prosthetic replacement and open reduction and internal fixation in treatment of adult with Mason type Ⅲ radial head fracture by a system assessment. Methods Prospective or retrospective studies of prosthetic replacement versus open reduction and internal fixation in treatment of adult with Mason type Ⅲ radial head fracture were retrieved in PubMed, MEDLINE, EBM, CbmWin, Wanfang Data and CNKI by computer, and major Chinese surgical journals such as Chinese orthopedic journals by hand. Mata analysis was also performed. Results A total of 6 studies were involved which included 2 prospective randomised control trial （RCT） and 4 retrieved clinical control trial （CCT）. Functional evaluation and complication by prosthetic replacement were significantly better than those by open reduction and internal fixation. The difference in heterotopic ossification and articular range of motion showed no statistical significance. Conclusion Prosthetic replacement is superior to open reduction and internal fixation in treatment of adult with Mason type Ⅲ radial head fracture in postoperative joint function and incidence rate of complication. Because long term follow-up is lack, further well-designed and large-scale RCT are required to confirm these findings.