OrthoEvidence Inc., Burlington, ON, Canada.
Department of Health, Evidence, and Impact, McMaster University, Hamilton, ON, Canada.
J Shoulder Elbow Surg. 2019 Mar;28(3):578-586. doi: 10.1016/j.jse.2018.10.019. Epub 2019 Jan 7.
The purpose of this study was to conduct a systematic review of studies comparing treatments for displaced radial head fractures (RHFs) and perform a network meta-analysis of randomized controlled trials (RCTs).
We searched electronic databases and reviewed the reference lists of included studies and prior systematic reviews. We included RCTs and cohort studies that (1) compared treatments for displaced RHFs in adults and (2) reported a functional outcome or postoperative complications. Data from RCTs were synthesized using a Bayesian network meta-analysis. We compared the proportion of patients categorized as "excellent" or "good" according to the Broberg and Morrey scale and the rate of postoperative complications using odds ratios (OR) with 95% credible intervals (CrI).
We included 20 studies (4 RCTs). The evidence from RCTs examined radial head arthroplasty (RHA), open reduction and internal fixation (ORIF) with metal implants (ORIF-M), and ORIF with biodegradable implants (ORIF-B). The network meta-analysis demonstrated that patients treated with an RHA had greater odds of achieving an "excellent" or "good" score compared with ORIF-M (OR, 22.5; 95% CrI, 2.73-299.58) and ORIF-B (OR, 11.83; 95% CrI, 0.58-324.57). For postoperative complications, RHA patients had a lower odds of experiencing a complication than ORIF-M (OR, 0.15; 95% CrI, 0.01-1.81) and ORIF-B (OR, 0.16; 95% CrI, 0.01-3.06) patients.
The network meta-analysis of RCTs indicated that RHA results in better function and reduced postoperative complications than ORIF-M and ORIF-B over 2 years in the treatment of displaced RHFs.
本研究旨在对比较桡骨头移位骨折（RHF）治疗方法的研究进行系统评价，并对随机对照试验（RCT）进行网络荟萃分析。
我们检索了电子数据库，并查阅了纳入研究和先前系统评价的参考文献列表。我们纳入了 RCT 和队列研究，这些研究（1）比较了成人桡骨头移位骨折的治疗方法，（2）报告了功能结果或术后并发症。使用贝叶斯网络荟萃分析综合 RCT 数据。我们使用优势比（OR）和 95%可信区间（CrI）比较了根据 Broberg 和 Morrey 量表分类为“优秀”或“良好”的患者比例以及术后并发症发生率。
我们纳入了 20 项研究（4 项 RCT）。RCT 研究的证据检查了桡骨头关节成形术（RHA）、金属植入物的切开复位内固定术（ORIF-M）和可生物降解植入物的切开复位内固定术（ORIF-B）。网络荟萃分析表明，与 ORIF-M（OR，22.5；95% CrI，2.73-299.58）和 ORIF-B（OR，11.83；95% CrI，0.58-324.57）相比，接受 RHA 治疗的患者获得“优秀”或“良好”评分的可能性更大。对于术后并发症，RHA 患者发生并发症的可能性低于 ORIF-M（OR，0.15；95% CrI，0.01-1.81）和 ORIF-B（OR，0.16；95% CrI，0.01-3.06）患者。
RCT 的网络荟萃分析表明，与 ORIF-M 和 ORIF-B 相比，RHA 在治疗桡骨头移位骨折的 2 年内可获得更好的功能和减少术后并发症。
