尺骨鹰嘴截骨入路与肱三头肌双侧入路治疗AO-C型肱骨远端骨折的meta分析  

Comparison between olecranon osteotomy and bilateral triceps approach for the treatment of AO-C type distal humeral fractures:a meta-analysis

作　　者：赵斌志 刘洋[1] 赵彦瑞[1] 单磊[1] 周君琳[1] Zhao Binzhi;Liu Yang;Zhao Yanrui;Shan Lei;Zhou Junlin(Department of Orthopaedic Surgery,Beijing Chaoyang Hospital,Capital Medical University,Beijing 100020,China)

机构地区：[1]首都医科大学附属北京朝阳医院骨科,北京100020

出　　处：《中华骨科杂志》2024年第17期1167-1175,共9页Chinese Journal of Orthopaedics

摘　　要：目的比较尺骨鹰嘴截骨入路与肱三头肌双侧入路内固定治疗AO-C型肱骨远端骨折的有效性和安全性。方法检索中国知网、万方、维普、中华医学期刊全文数据库、PubMed、Embase、Web of Science、Cochrane Library数据库等有关尺骨鹰嘴截骨入路与肱三头肌双侧入路内固定治疗AO-C型肱骨远端骨折的临床研究。检索时间为2017年1月至2023年3月。对纳入文献进行meta分析, 组间异质性较大时采用随机效应模型进行分析, 组间异质性较小时采用固定效应模型进行分析。随机对照试验采用改良Jadad评分量表进行文献质量评价, 非随机对照试验采用纽卡斯尔-渥太华量表(Newcastle-Ottawa Scale, NOS)进行文献质量评价。结果共15篇文献纳入meta分析, 其中随机对照试验3篇, 非随机对照试验12篇。经尺骨鹰嘴截骨入路内固定480例, 经肱三头肌双侧入路443例。Meta分析结果显示经尺骨鹰嘴截骨入路的手术时间长于经肱三头肌双侧入路[SMD=0.96, 95%CI(0.23, 1.70), P=0.010], 术中出血量大于经肱三头肌双侧入路[SMD=1.00, 95%CI(0.22, 1.78), P=0.012];两组术后梅奥肘关节功能评分[SMD=0.55, 95%CI(-0.23, 1.32), P=0.167]、复位优良率[OR=0.98, 95%CI(0.75, 1.27), P=0.856]、术后并发症发生率[OR=1.27, 95%CI(0.77, 2.09), P=0.344]、骨折愈合时间[SMD=-0.13, 95%CI(-0.37, 0.11), P=0.280]和肘关节活动范围[SMD=-0.02, 95%CI(-0.29, 0.26), P=0.891]的差异无统计学意义。结论肱三头肌双侧入路内固定治疗AO-C型肱骨远端骨折的手术时间更短、术中出血量更少, 两种手术方式的术后功能恢复无差异。Objective To compare the efficacy and safety of internal fixation using the olecranon osteotomy approach ver-sus the bilateral triceps approach for the treatment of AO type C distal humeral fractures.Methods We conducted a systematic search of China National Knowledge Infrastructure(CNKI),Wanfang,VIP,Chinese Medical Journal Full-Text Database,PubMed,Embase,Web of Science,and Cochrane Library for clinical studies comparing the olecranon osteotomy approach with the bilateral triceps approach for the treatment of A0 type C distal humeral fractures.The search period was from January 2017 to March 2023.A meta-analysis was performed on the included studies.Random-effects models were used for analyses with high inter-group het-erogeneity,while fixed-effects models were applied for those with low inter-group heterogeneity.Results A total of 15 studies were included in the meta-analysis,comprising 480 cases treated via the olecranon osteotomy approach and 443 cases via the bilat-eral triceps approach.Meta-analysis results showed that the olecranon osteotomy approach was associated with longer operative time[SMD=0.96,95%CI(0.23,1.70),P=0.010]and more intraoperative blood loss[SMD=1.00,95%CI(0.22,1.78),P=0.012]compared to the bilateral triceps approach.There were no statistically significant differences between the two groups in postopera-tive Mayo Elbow Performance Score[SMD=0.55,95%CI(-0.23,1.32),P=0.167],excellent and good reduction rate[0R=0.98,95%C(0.75,1.27),P=0.856],postoperative complication rate[0R=1.27,95%C(0.77,2.09),P=0.344],healing time[SMD=-0.13,95%CI(-0.37,0.11),P=0.280],and range of motion of the elbow joint[SMD=-0.02,95%CI(-0.29,0.26),P=0.891].Conclusion The bilateral triceps approach for internal fixation of AO type C distal humeral fractures is associated with shorter operative time and lower intraoperative blood loss compared to the olecranon osteotomy approach.The bilateral triceps approach for internal fixation of AO type C distal humeral fractures is associated with shorter operative time and lower in

关 键 词：肱骨骨折 骨折固定术 内 META分析 

分 类 号：R687.3[医药卫生—骨科学]