假体置换和切开复位内固定治疗Mason Ⅲ型桡骨头骨折的Meta分析

Meta- analysis of prosthetic replacement versus open reduction and internal fixation for treatment of Mason type III radial head fractures

[目的]系统评价假体置换和切开复位内固定治疗MasonⅢ型桡骨头骨折的疗效和安全性。[方法]计算机检索2004年6月~2014年6月期间在Pub Med、MEDLINE、Cochrane Library、CBM、CNKI、万方和维普数据库中公开发表的假体置换和切开复位内固定治疗MasonⅢ型桡骨头骨折的文献,对文献依据Cochrane系统评价方法学进行质量评价,用Rev Man 5.2软件进行Meta分析。[结果]最终共纳入3篇随机对照研究,8篇回顾性病例对照研究,共411例患者,所有文献的质量普遍不高,Meta分析结果显示：（1）在Broberg and Morrey肘关节功能优良率、评分以及术后并发症方面,假体置换要显著优于切开复位内固定（P〈0.000 01）;（2）在肘关节活动度方面两者比较无显著差异;（3）在VAS评分方面两者的优劣尚无定论。[结论]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一定的优势,但目前还欠缺对假体置换的中长期随访结果,故仍需低风险、高质量的临床试验研究进一步加以验证。

[Objective]To assess the effectiveness and safety of prosthetic replacement versus open reduction and internal fixation for treatment of Mason type III radial head fractures. [Method]Literature about the treatment of Mason type III radial head fractures by prosthetic replacement or open reduction and internal fixation（ published between 2004 and 2014） were searched and collected using the following databases： Pub Med,MEDLINE,Cochrane Library,CBM,CNKI,WANFANG,and VIP. Methodological quality of the literature was assessed using the Cochrane system evaluation methodology. Meta-analysis was performed using Rev Man 5. 2 software. [Result]Eventually,three randomized controlled trials and eight clinical controlled trials including 411 cases were enrolled in this study. Some of the trials did not have adequate methodological quality. Meta-analysis results indicated that the Broberg and Morrey elbow function score,elbow function score,and postoperative complications were significantly superior in patients who underwent prosthetic replacement compared with those who underwent open reduction and internal fixation（ P 0. 000 01）. However,there was no significant difference in elbow activity. In addition,we could not make a conclusion regarding the visual analog scale score. [Conclusion]Compared with open reduction and internal fixation,prosthetic replacement has certain advantages for treatment of Mason type III radial head fractures. Owing to a lack of long-term follow-up,low-risk and high-quality clinical trials are still needed to verify these findings.