寻找最佳治疗模式：一项针对儿童桡骨头半脱位初始治疗失败后手法干预的系统评价和荟萃分析。

Finding the optimal treatment model: a systematic review and meta- analysis of manipulative interventions following failed initial treatment of radial head subluxation in children.

机构信息

The 940th Hospital of Joint Logistics Support Force of People's Liberation Army, Lanzhou, 730030, China.

Orthopedics,Chengdu Women's and Children's Central Hospital, School of Medicine, University of Electronic Science and Technology of China, Chengdu, 611731, China.

出版信息

BMC Musculoskelet Disord. 2024 Nov 26;25(1):957. doi: 10.1186/s12891-024-08089-3.

DOI:10.1186/s12891-024-08089-3

PMID:39587502

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC11590256/

Abstract

BACKGROUND

The hyperpronation (HP) maneuver, known for its high success rate in reducing radial head subluxation after initial treatment failure, has gained significant favor among surgeons over the traditional supination-flexion (SF) maneuver. Despite its perceived advantages, the optimal treatment approach remains a topic of debate in the medical community due to uncertainties surrounding repeat and crossover reduction outcomes. Further research and clinical assessments are needed to establish a definitive treatment protocol ensuring optimal patient outcomes. This systematic review and meta-analysis aim to compare the efficacy of HP and SF maneuvers following unsuccessful initial treatments for radial head subluxation.

METHODS

A thorough search of PubMed, Embase, and Cochrane Library databases up to May 13, 2024 was conducted. The Cochrane risk-of-bias tool evaluated study quality, and RevMan 5.3 facilitated systematic review calculations. Subgroup analyses explored reasons for heterogeneity by considering second reduction attempts with crossover and repeat maneuvers. Sensitivity analyses using fixed and random effects models were performed for ambiguous decisions.

RESULTS

Nine studies with 170 patients were analyzed. The success rate for the second reduction was significantly higher with HP (OR = 2.48, 95% CI 1.18 to 5.20, P = 0.02) compared to SF. Repeat maneuver success rate for the second reduction also favored HP (OR = 3.79, 95% CI 1.57 to 9.16, P<0.01). However, no significant difference was found in the success rate of the crossover maneuver for the second reduction (OR = 0.75, 95% CI 0.16 to 3.47, P = 0.71).

CONCLUSION

The initial reduction method was unclear, possibly favoring HP over SF following initial treatment failure for radial head subluxation in children. When the initial reduction technique is clear, the choice between HP and SF for second reduction can be adjusted based on the physician's proficiency in the method and the patient's cooperation.

摘要

背景

在初次治疗失败后，高度旋前（HP）手法因其高复位成功率而受到外科医生的青睐，取代了传统的旋后-屈腕（SF）手法。尽管 HP 手法具有优势，但由于对重复和交叉复位结果的不确定性，其仍是医学界争论的话题。需要进一步的研究和临床评估来建立一个明确的治疗方案，以确保最佳的患者结果。本系统评价和荟萃分析旨在比较 HP 和 SF 手法在初次治疗桡骨头半脱位失败后的疗效。

方法

对 PubMed、Embase 和 Cochrane Library 数据库进行了全面检索，检索时间截至 2024 年 5 月 13 日。Cochrane 偏倚风险工具评估了研究质量，RevMan 5.3 软件用于系统评价计算。亚组分析通过考虑交叉和重复手法的第二次复位尝试来探讨异质性的原因。对于有歧义的决策，使用固定和随机效应模型进行敏感性分析。

结果

共分析了 9 项研究的 170 名患者。与 SF 相比，HP 手法的第二次复位成功率显著更高（OR=2.48，95%CI 1.18 至 5.20，P=0.02）。第二次复位的重复手法成功率也倾向于 HP（OR=3.79，95%CI 1.57 至 9.16，P<0.01）。然而，第二次复位的交叉复位手法成功率无显著差异（OR=0.75，95%CI 0.16 至 3.47，P=0.71）。