肘关节置换与切开复位钢板内固定术治疗老年肱骨远端骨折的荟萃分析

Total elbow arthroplasty versus open reduction and internal fixation for distal humeral fracture in the elderly: A meta-analysis

[目的]系统评价肘关节置换(total elbow arthroplasty,TEA)与切开复位钢板内固定术(open reduction and internal fixation,ORIF)治疗老年肱骨远端骨折的有效性。[方法]计算机检索电子数据库Pubmed,EMbase,The Cochrane library(2018年第01期),CBM,中国知网(CNKI),万方(Wan Fang),搜集肘关节置换与切开复位钢板内固定术治疗老年肱骨远端骨折疗效比较的临床研究,检索时间均为自建库至2018年01月。由2位评价员独立筛选文献、提取资料并评价纳入研究的偏倚风险后,运用Revman 5.3软件进行Meta分析。[结果]最终纳入7篇文献,共587例患者。Meta分析结果显示:术后Mayo肘关节功能评分的Meta分析结果显示TEA组的MEPS评分并不优于ORIF组(WMD=6.71,95%CI=-5.29～18.71,P=0.27),术后并发症发病率的Meta分析结果仍然显示TEA组的术后并发症发生率并不低于ORIF组(OR=0.92,95%CI=0.53～1.57,P=0.75)。森林结构图显示本次研究结果较为稳健,漏斗图提示存在发表偏倚的可能性较小。[结论]TEA与ORIF治疗老年肱骨远端骨折的临床疗效相近。

[Objective] To systematically review the outcomes of total elbow arthroplasty （TEA） versus open reduction and internal fixation （ORIF） for distal humeral fracture in the elderly. [Methods] Databases including PubMed, EMbase, The Cochrane Library （Issue 01, 2018）, CBM, CNKI and WanFang Data were electronically searched for the published studies involv ing the trails of TEA versus ORIF for treatment of distal humeral fracture in the elderly from inception to January.2018. Two reviewers independently screened literature, extracted data and assessed the risk of bias of included studies. Then, meta-analysis was performed using RevMan 5.3 software. [Results] A total of 7 studies involving 587 patients were included into this study. In term of the MEPS （mayo elbow performance score, the TEA group was not significantly superior to the ORIF group （WMD=6.71, 95%CI=-5.29-18.71, P=0.27） . Regarding to incidence of complications, the TEA group was also similar to the ORIF group （OR=0.92, 95%CI=0.53-1.57, P=0.75） . The forest structure figure showed that this result was reliable and less likely present publication bias. [Conclusion] Both TEA and ORIF have similar outcome for distal humeral fracture in the elderly.