两种术式治疗儿童桡骨颈骨折疗效的Meta分析

Comparing two surgical methods for radial neck fractures in children： a Meta-analysis

目的通过Meta分析系统评价闭合复位弹性髓内钉固定术与切开复位克氏针固定术对于儿童桡骨颈骨折的临床疗效。方法检索相关数据库，收集包括两种术式在内的治疗儿童桡骨颈骨折的对照试验，提取数据，进行质量评价，并通过Rev Man 5.3软件进行系统评价，比较两组术后骨折断端复位情况、术后肘关节功能恢复情况、总的并发症发生情况、去除固定后骨折再移位、皮肤激惹症状、桡神经损伤、桡骨头骨骺早闭等结局指标。结果本次Meta分析共纳入9篇文献。结果表明，对于儿童桡骨颈骨折，闭合复位组与切开复位组在术后骨折断端复位情况方面差异无统计学意义[RR＝0.98，95%CI（0.86，1.11），P＝0.72]；在总的并发症发生情况方面差异无统计学意义[RR＝0.61，95%CI（0.24，1.60），P＝0.32]；在皮肤激惹症状方面差异无统计学意义[RR＝0.08，95%CI（0.00，1.40），P〈0.08]；在桡神经损伤方面差异无统计学意义[RR＝1.22，95%CI（0.13，11.20），P〈0.86]；在桡骨头骨骺早闭方面差异无统计学意义[RR＝0.20，95%CI（0.02，1.64），P＝0.13]；在去除固定后骨折再移位方面，由于原始文献较少，该指标暂无可比性，尚需更多临床研究得出结论。在术后肘关节功能恢复方面，闭合复位组占有较大优势，差异有统计学意义[RR＝0.28，95%CI（0.16，0.52），P〈0.000 1]。结论闭合复位弹性髓内钉固定治疗儿童桡骨颈骨折术后疗效优于切开复位克氏针固定，在并发症的预防方面并无明显优势。但仍需要更多大样本、双盲、高质量的随机对照研究加以论证。

ObjectiveTo evaluate the clinical efficacies of closed reduction with elastic intramedullary nailing versus open reduction with Kirschner wire fixation for radial neck fractures in children.MethodsThe relevant databases were searched for comparative studies of closed reduction with elastic intramedullary nailing versus open reduction with Kirschner wire fixation for treating radial neck fractures in children. After extracting literature reports and quality evaluations, Rev Man 5.3 software was used for systematic review. Quality of post-operative fracture reduction, status of post-operative functional recovery of elbow joint, complications, fracture re-displacement after fixation removal, skin irritation, radial nerve injury and early closure of radial bone epiphysis were analyzed.ResultsA total of 9 literature reports were included for this Meta-analysis. For treating radial neck fractures in children, no significant inter-group difference existed in quality of post-operative fracture reduction [RR=0.98, 95%CI（0.86, 1.11）, P=0.72]; complications[RR=0.61, 95%CI（0.24, 1.60）, P=0.32]; skin irritation [RR=0.08, 95%CI（0.00, 1.40）, P〈0.08]; radial nerve injury [RR=1.22, 95%CI（0.13, 11.20）, P〈0.86]; early closure of radial bone epiphysis [RR=0.20, 95%CI（0.02, 1.64）, P=0.13]. Additional articles were required for assessing the rate of fracture re-displacement after fixation removal. The results of Meta-analysis showed that closed reduction group was superior to open reduction group in status of post-operative functional recovery of elbow joint after treatment [RR=0.28, 95%CI （0.16, 0.52）, P〈0.0001]. ConclusionsClosed reduction with elastic intramedullary nailing is superior to open reduction with Kirschner wire fixation in treating radial neck fractures in children. However, it offers no advantage of preventing complications. And larger sample size, double-blind and high-quality randomized controlled trials are warranted for confirming the results.