手术与非手术治疗孤立性 Mason Ⅱ型桡骨头骨折的比较：系统评价和荟萃分析。

Comparison of operatively and nonoperatively treated isolated mason type II radial head fractures: a systematic review and meta-analysis.

机构信息

Department of Orthopedic Surgery, Beijing Chaoyang Hospital, Capital Medical University, 8 Gongren Tiyuchang Nanlu, Chaoyang District, Beijing, 100020, P.R. China.

出版信息

J Orthop Surg Res. 2024 Sep 4;19(1):540. doi: 10.1186/s13018-024-05039-6.

DOI:10.1186/s13018-024-05039-6

PMID:39227938

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC11373464/

Abstract

BACKGROUND

Radial head fractures are the most common bony injury of the elbow in adults. The current literature does not agree on whether isolated stable type II radial head fractures should be treated operatively or nonoperatively. This review aims to determine the preferred treatment for Mason type II radial head fractures and compare the outcomes of conservative and surgical treatment.

METHODS

Our study used PRISMA guidelines and conducted a thorough search of multiple electronic databases, including PubMed, Cochrane, Embase, Web of Science, CNKI, and Wanfang databases, initially identifying 545 relevant publications on surgical and conservative treatment of Mason type II radial head fractures. The final search date for this study is July 7, 2024.Through a comprehensive meta-analysis, we evaluated several outcomes, including functional scores (DASH, OES, and MEPS scores), clinical outcomes (elbow flexion, elbow extension deficit, elbow pronation, and elbow supination), and complication rate (total complications and elbow pain). The mean difference (MD) was compared for continuous outcomes, and the odds ratios (ORs) were compared for categorical outcomes.

RESULT

A total of 271 patients from 4 studies met the inclusion criteria. Among them, 142 patients received surgical treatment and 129 patients received non-surgical treatment. The study found no statistically significant differences between surgical and non-surgical treatments in DASH, OES, MEPS, elbow flexion, elbow extension impairment, and elbow pain. Compared with surgical treatment, non-surgical treatment was associated with greater elbow pronation (OR = -3.10, 95% CI = [-4.96, -1.25], P = 0.55, I = 0%) and a lower complication rate (OR = 5.54, 95% CI = [1.79, 17.14], P = 0.42, I = 0%).

CONCLUSION

Based on the current evidence, conservative management of isolated Mason II radial head fractures yields favorable therapeutic outcomes with a low incidence of complications.

摘要

背景

桡骨头骨折是成年人肘部最常见的骨折。目前的文献对于是否应手术或非手术治疗孤立稳定型 II 型桡骨头骨折尚无定论。本综述旨在确定 Mason II 型桡骨头骨折的首选治疗方法，并比较保守治疗和手术治疗的结果。

方法

我们的研究使用 PRISMA 指南，对多个电子数据库（包括 PubMed、Cochrane、Embase、Web of Science、CNKI 和万方数据库）进行了全面检索，最初确定了 545 篇关于 Mason II 型桡骨头骨折手术和保守治疗的相关文献。本研究的最终检索日期为 2024 年 7 月 7 日。通过全面的荟萃分析，我们评估了几种结局，包括功能评分（DASH、OES 和 MEPS 评分）、临床结局（肘部屈曲、肘部伸展不足、肘部旋前和肘部旋后）和并发症发生率（总并发症和肘部疼痛）。连续结局采用均数差（MD）进行比较，分类结局采用比值比（OR）进行比较。

结果

共有 4 项研究的 271 名患者符合纳入标准。其中，142 名患者接受手术治疗，129 名患者接受非手术治疗。研究发现，手术治疗与非手术治疗在 DASH、OES、MEPS、肘部屈曲、肘部伸展不足和肘部疼痛方面无统计学差异。与手术治疗相比，非手术治疗与更大的肘部旋前（OR = -3.10，95%CI = [-4.96，-1.25]，P = 0.55，I = 0%）和较低的并发症发生率（OR = 5.54，95%CI = [1.79，17.14]，P = 0.42，I = 0%）相关。