切开复位内固定与全肘关节置换治疗老年肱骨远端骨折的Meta分析

Meta-analysis of open reduction and internal fixation versus total elbow arthroplasty for distal humeral fracture in the elderly

背景:治疗老年肱骨远端骨折最常见的手术方式是切开复位内固定与全肘关节置换,而两者之间的疗效是否存在差异仍缺乏系统评价,需要进一步研究,以更好的指导临床工作。目的:比较切开复位内固定与全肘关节置换治疗老年肱骨远端骨折临床疗效的差异。方法:计算机检索PubMed、The Cochrane library、EMBASE、ScienceDirect、CNKI、万方、维普等数据库。搜集有关比较切开复位内固定/全肘关节置换治疗老年肱骨远端骨折的观察队列研究或随机对照试验的文献,检索年限为1998至2018年。2人独立完成阅读筛选文献,提取数据和评价研究质量,采用RevMan5.3进行数据分析。结果与结论:①共纳入10项研究,1069例患者;②Meta结果显示,全肘关节置换组在总并发症发生率(OR=1.67,95%CI:1.19-2.35,P=0.003)、末次随访Mayo肘关节功能评分(MD=-12.68,95%CI:-16.60至-8.77,P <0.000 01)、肘关节屈伸活动度(MD=-14.64,95%CI:-19.56至-9.71,P <0.000 01)、上肢功能评分(MD=12.99,95%CI:6.47-19.51,P <0.000 1)方面均优于切开复位内固定组,差异有显著性意义;③平均手术时间、感染、异位骨化、并发症/再次手术方面2组差异无显著性意义(P>0.05);④提示全肘关节置换组患者术后总并发症发生率低于切开复位内固定组,且可以获得优于切开复位内固定组的肘关节功能。对于老年肱骨远端骨折,患者伴有不同程度骨质疏松,关节面难以有效复位,应考虑全肘关节置换治疗。

BACKGROUND: The most common surgical procedure for the treatment of distal humeral fracture in the elderly is open reduction and internal fixation and total elbow arthroplasty. There is still a lack of systematic evaluation of the efficacy between the two methods, and further research is needed to better guide clinical work. OBJECTIVE: To compare the clinical efficacy of open reduction and internal fixation combined with total elbow arthroplasty in the treatment of elderly patients with distal humeral fractures. METHODS: The computer was used to retrieve information in databases such as PubMed, The Cochrane Library, EMBASE, ScienceDirect, CNKI, Wanfang, and VIP. An observational cohort study or randomized controlled trial was performed in the study of open reduction and internal fixation/total elbow arthroplasty for the treatment of elderly patients with distal humeral fractures. The search period was 1998-2018. Studies were read and screened;data were extracted and the quality of the study was assessed by two persons independently. Dat a analysis was performed using RevMan 5.3. RESULTS AND CONCLUSION:(1) A total of 10 studies were included in 1 069 patients.(2) Meta-analysis results showed that total elbow arthroplasty group was superior to the open reduction and internal fixation group in the incidence of total complications(OR=1.67, 95%CI: 1.19–2.35, P=0.003), Mayo elbow performance score at the last follow-up(MD=-12.68, 95%CI:-16.60 to-8.77, P < 0.000 01), flexion and extension of elbow joint(MD=-14.64, 95%CI:-19.56 to-9.71, P < 0.000 01), disabilities of the arm, shoulder, and hand questionnaire(MD=12.99, 95%CI: 6.47–19.51, P < 0.000 1).(3) The mean operation time, infection, heterotopic ossification, and complications/reoperation were not statistically significant between the two groups(P > 0.05).(4) These results confirmed that the total complication rate of the total elbow arthroplasty group was lower than that of the open reduction and internal fixation group, and the elbow joint function was better than that of the open reduction and internal fixation group. For elderly patients with distal humeral fracture, the degree of osteoporosis is different, and the articular surface is difficult to be effectively reset. The treatment of total elbow arthroplasty should be considered.