尺骨鹰嘴截骨入路与肱三头肌内外侧入路对肱骨髁间C型骨折临床疗效的荟萃分析

Clinical Efficacy of the Olecranon Osteotomy Approach and the Bilateral Triceps Brachii Surgical Approach in the Treatment of Humeral Condylar Fractures: a Meta-Analysis

目的评价经尺骨鹰嘴截骨入路与肱三头肌内外侧入路手术治疗肱骨髁间C型骨折的疗效及安全性。方法检索Embase、Pub Med、Cochrane图书馆、中国知网、维普、万方数据等数据库2017年5月1日前公开发表的经尺骨鹰嘴截骨入路或肱三头肌内外侧入路治疗肱骨髁间C型骨折的对照研究,2名评价者严格按照纳入及排除标准筛选文献。对相关数据采用Rev Man5.3软件进行Meta分析。结果共纳入12篇文献;Meta分析结果:尺骨鹰嘴截骨组与肱三头肌内外侧组比较,肘关节总功能优良率不具有统计学意义[RR=0.90,95%CI(0.75,1.08),I2=72%,P=0.26];两组手术时间具有统计学意义[MD=-18.59,95%CI(-35.42,-1.76),I2=97%,P=0.03];两组并发症总发生率不具有统计学意义[RR=1.13,95%CI(0.61,2.10),I2=60%,P=0.69];两组出血量具有明显统计学意义[MD=-22.08,95%CI(-41.92,-2.24),I2=86%,P=0.03]。结论对肱骨髁间骨折C型,尺骨鹰嘴截骨入路更具有优势。

Objective To evaluate the clinical efficacy and safty of the olecranon osteotomy approach and the bilateral triceps brachii surgical approach for the treatment of type C humeral condylar fractures.Methods Pubmed,Cochrane Library,Springer Link,VIP,Wanfang,CNKI database were searched from inception to May 1,2017 for published trails of C type humeral condylar fracture patients,who were operated with olecranon osteomy incision or bilateral triceps brachii incision,on the basis of strict inclusion and exclusion criteria. The relevant data were extracted,and analyzed with Review Manager 5.3. Results 12 studies were incorporated. Meta-analysis results showed that there was no statistically significant difference on the total elbow scores in the two kinds of surgical approaches[RR = 0. 90,95% CI（0. 75,1. 08）,I2= 72%,P = 0. 26]. There was a statistically significant differnce on surgical time [MD =-18.59,95%CI（-35.42,-1.76） I2= 97%,P = 0.03]. There was no statistically significant difference on postoperative complications[RR = 1.13,95%CI（0.61,2.10）,I2= 60%,P = 0. 69]. There was statistically significant difference on the amount of bleeding[MD =-22.08,95%CI（-41.92,-2.24）,I2= 86%,P = 0.03]. Conclusions There are obvious advantages of the oclecranon osteotomy approach in the treatment of C type humeral condylar fractures.