闭合与切开复位克氏针固定治疗儿童肱骨外髁骨折疗效与安全性的Meta分析

Efficacy and Safety of Closed Reduction Percutaneous Pinning versus Open Reduction with Kirschner Wire Fixation for Paediatric Lateral Humeral Condyle Fractures:a Meta-analysis

背景对于移位明显的儿童肱骨外髁骨折,传统治疗方法为切开复位后内固定治疗,但近年来采用闭合复位后克氏针固定治疗儿童肱骨外髁骨折的报道渐多,但究竟哪种手术方式的疗效与安全性更高,存在一定的争议。目的对闭合复位经皮穿针(CRPP)、切开复位克氏针内固定(ORKF)在小儿肱骨外髁骨折中的应用效果及安全性进行评价。方法计算机检索包括中国知网、万方数据知识服务平台、维普网、中国生物医学文献数据库、PubMed、Embase、Cochrane Library和Web of Science在内的中文和英文数据库,检索时间为各数据库建立至2023-01-01。筛选两种手术方法治疗小儿肱骨外髁骨折的病例对照研究后,对其进行文献质量评价并提取数据。运用RevMan 5.3软件进行Meta分析,对两种手术方式的相关疗效及安全性指标进行比较。结果共纳入16篇文献进行Meta分析,包括1165例患儿。Meta分析结果显示,CRPP组患儿手术时间短于ORKF组(MD=-11.81,95%CI=-15.04~-8.58,P<0.00001),术中出血量低于ORKF组(MD=-3.36,95%CI=-4.37~-2.36,P<0.00001),术后骨折愈合时间短于ORKF组(MD=-3.92,95%CI=-6.80~-1.03,P=0.008),克氏针存留时间短于ORKF组(MD=-3.35,95%CI=-6.33~-0.38,P=0.03),术后肘关节功能恢复不良率低于ORKF组(OR=0.44,95%CI=0.25~0.76,P=0.006),术后总体并发症的发生率低于ORKF组(OR=0.33,95%CI=0.19~0.56,P<0.0001),浅表感染的发生率低于ORKF组(OR=0.39,95%CI=0.21~0.73,P=0.003);而两组深部感染、不良愈合、肱骨外髁缺血坏死发生率比较,差异无统计学意义(P>0.05)。结论CRPP治疗儿童肱骨外髁骨折,无论从效果还是从整体并发症上均优于ORKF,但在具体并发症方面尚需更多高质量文献进一步验证。

Background Traditionally,open reduction with Kirschner wire fixation(ORKF)is used to treat paediatric patients with significantly displaced lateral humeral condyle fractures.However,in recent years,the use of closed reduction percutaneous pinning(CRPP)to treat lateral humeral condyle fractures in children has been increasingly reported.However,there is some controversy as to which surgical technique is more effective and safe.Objective To evaluate the efficacy and safety of CRPP and ORKF in paediatric patients with lateral humeral condyle fractures.Methods Chinese databases including CNKI,Wanfang Data,VIP and CBM and English databases including PubMed,Embase,Cochrane Library and Web of Science were searched from inception to 2023-01-01 for the case-control studies of CRPP and ORKF to treat the lateral humeral condyle fractures,the quality of the literature was evaluated and data were extracted.RevMan 5.3 software was performed to conduct a meta-analysis comparing the relevant efficacy and safety indexes of the two surgical techniques.Results A total of 16 studies involving 1165 cases were included for this meta-analysis.The results of meta-analysis indicated that CRPP was superior in status of surgical time(MD=-11.81,95%CI=-15.04 to-8.58,P<0.00001),intraoperative bleeding(MD=-3.36,95%CI=-4.37 to-2.36,P<0.00001),postoperative fracture healing time(MD=-3.92,95%CI=-6.80 to-1.03,P=0.008),Kirschner wire rtention time(MD=-3.35,95%CI=-6.33 to-0.38,P=0.03),and postoperative functional recovery of elbow joint(OR=0.44,95%CI=0.25 to 0.76,P=0.006).The incidence of overall postoperative complications(OR=0.33,95%CI=0.19 to 0.56,P<0.0001)and superficial infections(OR=0.39,95%CI=0.21 to 0.73,P=0.003)was lower than that in the ORKF group.However,there is no statistically significant difference in the deep infections,poor fracture healing,and ischemic necrosis of the lateral condyle between the two groups(P>0.05).Conclusion CRPP was superior to ORKF in the treatment of pediatric lateral humeral condyle fractures,both in terms of efficacy and overall complications,but more high-quality studies are needed to further validate CRPP in terms of specific complications.