TTIE中桡骨头骨折切开复位内固定与桡骨头置换疗效对比的Meta分析-中华老年骨科与康复电子杂志

文章信息/Info

Title:: Radial head arthroplasty versus Open reduction and internal fixation for the treatment of the terrible triad injury of the elbow: a systematic review and Meta-analysis

作者:: 王云鹭1; 李锡勇1; 刘伦1; 张鹏2; 韩鹏飞3; 李晓东2; 046000 长治医学院研究生院1；046000 长治市第二人民医院骨科2；046000 长治医学院附属和平医院骨科

Author(s):: Wang Yunlu1; Li Xiyong1; Liu Lun1; Zhang Peng2; Han Pengfei3; Li Xiaodong2; 1Graduate School of Changzhi Medical College, Changzhi 046000, China; 2Department of Orthopedics, The Second People’s Hospital of Changzhi City, Changzhi 046000, China; 3Department of Orthopedics, Heping Hospital Affiliated To Changzhi Medical College, Changzhi 046000, China

Keywords:: Terrible triad injury of the elbow; Radial head arthroplasty; Open reduction internal fixation

摘要:: 目的通过这次Meta分析比较桡骨头置换与切开复位内固定在治疗肘关节恐怖三联征（TTIE）桡骨头骨折时疗效的差异。方法计算机检索自2013年3月至2022年3月在Pubmed、Web of Science、Embase、Cochrane Central Register of Controlled Trials （Central）、Cinahl、Medline、Cochrane Library、CBM、CNKI等数据库公开发表的切开复位内固定（ORIF）和假体置换（RHA）治疗TTIE中桡骨头骨折的文献，依据检索策略，共检索到相关文献1 141篇，并最终纳入12篇文献。根据Cochrane系统分析法，由两名评价员从纳入的研究中独立提取数据，并使用RevMan 5.4进行分析，并评估研究质量。结果通过Meta分析发现，手术治疗肘关节恐怖三联征时，RHA组术后前臂伸展活动度[95% CI（-5.53，-1.50），P＜0.001]和术后并发症发生率[95% CI（0.20，0.79），P=0.008]上优于ORIF治疗的患者，差异有统计学意义。Mayo肘关节功能（MEPS）评分、上肢功能障碍评定量表（DASH）评分和旋转活动度方面二者比较差异无统计学意义。结论 RHA组较ORIF组术后具有更优异的前臂伸展活动度和更少的术后并发症发生，因此在治疗肘关节恐怖三联征时，RHA优于ORIF。

Abstract:: Objective The differences of efficacy between RHA and ORIF for the treatment of terrible triad injury of the elbow (TTIE) were compared in this Meta-analysis. Methods We searched the literatures published in databases such as Pubmed, Web of Science, Embase, Cochrane Central Register of Controlled Trials (Central), Cinahl, Medline, Cochrane Library, CBM, CNKI, etc., from March 2013 to March 2022. A total of 1, 141 related literatures were retrieved, and 12 literatures were finally included. Data from included studies were extracted independently by two reviewers, analysed using RevMan 5.4, and study quality was assessed according to Cochrane systematic analysis. Results On surgical treatment for TTIE, we found that forearm extension range of motion after surgery in RHA group [95% CI: -5.53, -1.50, P<0.001] was superior to ORIF, with lower incidence of complications [95% CI: 0.20, 0.79, P<0.001], and the difference was statistically significant. Meanwhile, there was no statistically significant difference in terms of Mayo Elbow Performance Score (MEPS) Score, Disabilities of the Arm, Shoulder and Hand (DASH) Score and elbow range of motion (flexion–extension arc). Conclusions Compared with the ORIF, the RHA group had better forearm extension range of motion and fewer complications after surgery, so RHA was superior to ORIF in the treatment of TTIE.