MasonⅡ、Ⅲ型桡骨小头骨折切除与内固定治疗的系统评价  

The Efficacy of Resection Versus Internal Fixation for Mason Type-Ⅱ Ⅲ Comminuted Fractures of Radial Head:A Systematic Review

作　　者：阿德力[1] 岳勇 王强[1] 阿斯卡尔[1] 

机构地区：[1]新疆医科大学第一附属医院骨科中心关节外科,新疆乌鲁木齐830054 [2]克拉玛依市人民医院骨科,新疆克拉玛依834000

出　　处：《实用骨科杂志》2008年第8期459-463,共5页Journal of Practical Orthopaedics

摘　　要：目的评价对MasonⅡ、Ⅲ型桡骨小头骨折行桡骨小头切除与内固定治疗的疗效。方法计算机检索数据库MEDLINE（1950-2007．4）、OVID数据库（1950-2007．11）、PUBMED（1950～2007．11）、中国生物医学文献数据CBM（1978—2007．11），万方数据库（1981～2007．11），手工检索《中华骨科杂志》、《骨与关节损伤》、《中华创伤骨科杂志》、《实用骨科杂志》、《临床骨科杂志》等5种中文骨科核心杂志（截自2007年10月），由两名评价员独立选择试验、提取资料并交叉核对，而后按Cochrane系统评价的方法评价纳入文献的方法学质量并提取有效数据进行Meta分析。结果共查到相关文献56篇。经阅读标题、摘要和全文后，有53篇因研究目的与本系统评价不符，而被排除。有3篇文章系临床对照试验（chrane controlleel trails，CCT）。3个CCT均可能存在选择性偏倚、实施偏倚和测量偏倚的高度可能性。结果共纳入3篇CCT，包括131例患者。3篇比较了切除与内固定治疗桡骨小头骨折的疗效。由于纳入的研究及病人太少，且结局评价指标差异较大，不能进行Meta分析，只能进行描述性系统评价（仅并发症一项指标进行了Meta分析），有三项研究支持切除组，原因系桡骨头切除后，缺少桡骨小头的支撑，导致肱桡关节、肱尺关节、上下桡尺关节不匹配，使肘关节伸肘肌力、前臂的旋前、旋后肌力术后均比内固定组明显减弱；有三项研究、支持VAS疼痛评分、Broderg和Morrey评分内固定高于切除组；有三项研究支持桡骨近端移位距离增大、提携角增加的度数、肘关节异位骨化及创伤性关节炎切除组明显增高；有两项研究支持切除组握力减弱；有三项研究支持切除组屈肘度数、屈肘肌力减弱与内固定组相似，内固定组的肘关节功能评分明显高于切除组。结论MasonⅡ、Ⅲ型桡骨小头骨折内固�Objective The efficacy of resection versus internal fixation for Mason type-Ⅱ Ⅲ comminuted fractures of radial head. Methods We searched MEDLINE（1950-2007.4）,OVID（1950-2007. 11）,and hand-searched several related journals for randomized controlled trials（RCTs）and quasi-randomized controlled trials （quasi-RCTs）involving the efficacy of resection versus internal fixation for Mason type- Ⅱ Ⅲ comminuted fractures of radial head：The quality of the included trials was assessed. RevMan 4.2, 8 software was used for statistical analysis. Results Three studies were included. （3 CCT）. A total of 131 patients were included. The results indicated that the huge heterogeneity consist in three studies.it shows that Meta-analysis can not be performed except one index of complication（degenerative change） ,three studies indicated that strength in extension pronation of forearm as well as supination of forearm was more decreased in resecnon group than in internal fixation group lack of suspension of the radial head：meantime.it supported that VAS scores Broderg and Morrey scores were greater in internal fixation group the average increase of ulnar variance the average increase m the carrying angle, degenerative change as well. The average loss in grip strength within resection was found in two studies. Result was same in two groups of the flexion of elbow and loss of strength in flexion. Obviously significant advantage were more observed in the internal fixation in the clinical outcome than that of resection. Conehlsion Although result obtained on the basis of CCT with a lager bias,We still conclucie that better strength and better, overall functional outcome were more observed in the internal fixation in the clinical outcome than that of resection ：More high quality,large-scale randomized controlled trials are required for the issue.

关 键 词：桡骨小头骨折 内固定 切除术 疗效 系统评价 临床对照试验 

分 类 号：R683.41[医药卫生—骨科学]