假体置换与切开复位内固定治疗成人MasonⅢ型桡骨头骨折临床结局的系统评价与Meta分析

Prosthetic replacement versus open reduction internal fixation for treating Mason type III radial head fractures in adults: a systematic review and meta-analysis of clinical outcome

背景:对于MasonⅢ型桡骨头骨折,采用何种术式治疗一直是争论的焦点。目的:比较假体置换与切开复位内固定治疗MasonⅢ型桡骨头骨折的术后优良率、并发症、肘关节功能。方法:计算机检索PubMed(1950/2014-03)、OVID(1950/2014-03)、MEDLINE(1950/2014-03)、EMBASE(1980/2014-03)、CENTRAL(The Cochrane Library,1993/2014)、CBM(1978/2014-03)、万方数据库(1981/2014-03)、CNKI(1979/2014-03)、维普数据库(1989/2014-03)。搜集MasonⅢ型桡骨头骨折假体置换及切开复位内固定的对照研究并加以系统评价。用Revmen5.1统计学软件进行异质性分析及Meta分析。结果:本研究最终纳入2篇随机对照试验和7篇临床对照试验,总计344例患者。采用假体置换155例,切开复位内固定189例。假体置换组优良率[OR=3.17,95%CI(1.78,5.65),P<0.0001],并发症[OR=0.22,95%CI(0.10,0.50),P=0.0003],Broberg-Morrey肘关节功能评分[WMD=12.43,95%CI(8.02,16.85),P<0.00001]与切开复位内固定组相比,均有明显优势。结论:现有的有限证据表明,通过优良率、肘关节功能评分及并发症评价证实人工假体置换治疗MasonⅢ型桡骨小头骨折较切开复位内固定具有更大优势,且差异具有统计学意义。受纳入文献数量和质量的限制,Meta分析结果尚有待与高质量的大样本随机对照试验予以证实。

Background：There is a certain controversy on the efficacy of different treatment modalities for Mason typeⅢradial head fracture. Objective：To evaluate the clinical outcome, complications and eblow function of prosthetic replacement versus open reduc-tion and internal fixation for the treatment of MasonⅢradial head fracture. Methods：We searched PubMed （1950/2014-03）, OVID （1950/2014-03）, MEDLINE （1950/2014-03）, EMBASE （1980/2014-03）, CENTRAL （The Cochrane Library, 1993/2014）, CBM （1978/2014-03）, Wangfang database （1981/2014-03）, CNKI （1979/2014-03）, and VIP （1989/2014-03）. The literature on the treatment of Mason typeⅢradial head fracture by prosthet-ic replacement and open reduction and internal fixation were collected and the effects were compared through Meta analy-sis. RevMan 5.1 statistical software was used to perform the heterogeneity analysis and Meta analysis. Results：Eventually, 7 controlled clinical trials and 2 randomized controlled trails including 344 cases were enrolled in this study. Of them, 155 patients underwent prosthetic replacement and 189 patients received open reduction and internal fixa-tion. The good rate [OR=3.17, 95%CI （1.78, 5.65）, P〈0.0001], incidence of complications [OR=0.22, 95%CI （0.10, 0.50）, P=0.0003] and elbow function recovery [WMD=12.43, 95%CI （8.02, 16.85）, P〈0.00001] in the patients undergoing pros-thetic replacement were statistically superior to those with open reduction and internal fixation. Conclusions： Compared with open reduction and internal fixation, prosthetic replacement is statistically superior in good rate, complication rate and eblow function for treating Mason typeⅢradial head fracture. Further well-designed and large-scale randomized controlled trials are required to confirm these findings.