Seok Hyun-Gyu, Park Jeong-Jin, Park Sam-Guk
Department of Orthopedics, Yeungnam University Medical Center, Daegu 41000, Korea.
J Clin Med. 2022 Sep 29;11(19):5775. doi: 10.3390/jcm11195775.
Distal humeral fractures are challenging injuries seen in the elderly. Open reduction and internal fixation (ORIF) are the gold standard treatments. Total elbow arthroplasty (TEA) is an alternative to ORIF. This study aimed to pool and analyze the outcomes and complications in elderly patients with distal humeral fractures treated with either ORIF or TEA by performing a meta-analysis. We searched the PubMed, Embase, Google Scholar, and Cochrane Library databases for studies that compared the clinical and functional outcomes of ORIF and TEA in patients aged 60 years or older. After screening and performing a quality assessment of the articles, we obtained one randomized control study and nine retrospective comparative studies. The odds ratio and standardized mean difference were used to analyze the differences in outcomes between the two surgical options. In terms of the flexion/extension arc, TEA produced significantly better outcomes than ORIF ( = 0.02). The rates of reoperation and elbow stiffness were significantly lower in the TEA group than in the ORIF group ( = 0.003 and = 0.04, respectively). However, the functional scores and other ranges of motion (flexion, loss of extension, pronation, supination) after surgery were similar between the two groups. The outcomes from the present meta-analysis can provide guidance when selecting a surgical option for distal humeral fractures in the elderly.
肱骨远端骨折是老年人常见的具有挑战性的损伤。切开复位内固定术（ORIF）是标准的治疗方法。全肘关节置换术（TEA）是ORIF的替代方案。本研究旨在通过荟萃分析汇总并分析接受ORIF或TEA治疗的老年肱骨远端骨折患者的疗效和并发症。我们在PubMed、Embase、谷歌学术和Cochrane图书馆数据库中检索了比较60岁及以上患者ORIF和TEA临床及功能结局的研究。在对文章进行筛选和质量评估后，我们获得了1项随机对照研究和9项回顾性比较研究。采用优势比和标准化均数差分析两种手术方式在结局方面的差异。在屈伸弧方面，TEA的疗效明显优于ORIF（P = 0.02）。TEA组的再次手术率和肘关节僵硬发生率明显低于ORIF组（分别为P = 0.003和P = 0.04）。然而，两组术后的功能评分及其他活动范围（屈曲、伸展丧失、旋前、旋后）相似。本荟萃分析的结果可为老年肱骨远端骨折手术方案的选择提供指导。
