切开复位内固定与假体置换对Mason Ⅲ型桡骨头骨折治疗效果的Meta分析

Meta-analysis on open reduction and internal fixation and prosthetic replacement for Mason Ⅲ radial head fracture healing

目的:评价假体置换(prosthesis replacement,PR)与开放复位内固定(open reduction and internalfixation,ORIF)两种手术干预方式对于Mason Ⅲ型桡骨头骨折(radial head fractures,RHF)患者的临床治疗效果。方法:从PubMed,Embase,Medline,Springer,Elsevier Science Direct,CochraneLibrary,Google scholar,CNKI及万方数据库中检索2012年1月至2018年1月的相关文献,通过计算加权平均差(weighted mean difference,WMD)、比值比(odds ratio,OR)以及95%可信区间来比较PR与ORIF的临床结果。结果:共检索到8项研究,262名Mason Ⅲ型RHF患者(140例接受PR治疗,122例接受ORIF治疗)。与ORIF干预相比,接受PR干预的Mason Ⅲ型RHF患者术后优良率上显著高于ORIF(OR=3.51,95%CI 1.99~6.20,P<0.001),更高的肘关节评分(WMD=11.07,95%CI7.13~15.01,P<0.001),以及更低的肘关节术后并发症(OR=0.29,95%CI 0.13~0.64,P=0.002)。结论: PR治疗Mason Ⅲ型RHF患者的手术效果及术后肘关节功能方面明显优于ORIF,但本研究证据质量低,需要进一步研究来证实本次研究结果。

Objective: To evaluate the clinical efficacy of two surgical interventions of prosthesis replacement (PR) and open reduction and internal fixation (ORIF) for Mason Ⅲ type radial head fracture. Methods: Relevant experiments from January 2012 to January 2018 were retrieved from several public databases, including Pubmed, EMBASE, Medline, Springer, Elsevier Science Direct, Cochrane Library, Google scholar, CNKI and Wanfang databases. The clinical results of PR and ORIF were compared by calculating weighted mean difference (WMD), odds ratio (OR) and 95% confidence interval (CI). Results: A total of 8 studies were retrieved. A meta-analysis was performed on 262 Mason Ⅲ RHF patients (140 treated with PR and 122 treated with ORIF). The results showed that, compared with ORIF, Mason Ⅲ RHF patients receiving PR intervention had significantly higher postoperative excellent rate and good rate (OR=3.51, 95%CI 1.99–6.20, P<0.0001) and higher elbow score (WMD=11.07, 95%CI 7.13–15.01, P=0.00001). And lower postoperative complications of elbow joint (OR=0.29, 95%CI 0.13–0.64, P=0.002). Conclusion: The results of this study showed that the surgical effect and postoperative elbow function of PR in Mason Ⅲ RHF patients were significantly better than that of ORIF. However, the quality of evidence in this study was low and further studies were needed to further confirm the conclusion of this study.