Abstract：
Background: The aim of this study is to compare the surgical and non-operative management of displaced radial head fractures via a network meta-analysis of randomised controlled trials (RCTs). Methods: RCTs comparing management of isolated, displaced radial head fractures in adults were included in our review and statistical analysis. A systematic review of electronic databases (Medline, Embase and Cochrane Library) were screened for comparative RCTs reporting on the management of displaced radial head fractures in August 2021. Two investigators independently reviewed studies for eligibility and an assessment of bias was performed for each study. A Bayesian network meta-analysis of the included RCTs was performed. Results: Five RCTs (326 patients) were included in our meta-analysis. Treatment methods included radial head arthroplasty (RHA), open reduction internal fixation (ORIF) with metal implants (ORIF-M), ORIF with biodegradable implants (ORIF-B) and non-operative management. In our network meta-analysis of \'good\' or \'excellent\' patient-reported outcome measures (PROMs), RHA was significantly favourable to ORIF-M (OR: 0.04, CrI: 0.0011, 0.87), ORIF-B (OR: 0.1 CrI: 0.00076, 6.37). Nonoperative treatment was not shown to be significantly worse than RHA (OR: 0.01 CrI: 2.5e-0.5, 3.61). Conclusions: This network meta-analysis shows that in displaced radial head fractures, RHA is associated with significantly superior functional PROMs than ORIF-M based on the evidence available. Nonoperative management has not been shown to be significantly worse. Level of Evidence: Level III (Therapeutic).
摘要：
背景：本研究的目的是通过随机对照试验（RCTs）的网络荟萃分析，比较移位的桡骨头骨折的手术和非手术治疗。方法：RCT比较孤立的管理，成人移位桡骨头骨折纳入我们的综述和统计分析.对电子数据库的系统审查(Medline，Embase和CochraneLibrary）于2021年8月进行了有关移位桡骨头骨折管理的比较RCT报告。两名研究人员独立审查了研究的资格，并对每项研究进行了偏倚评估。对纳入的RCT进行贝叶斯网络荟萃分析。结果：5例RCT（326例）纳入我们的荟萃分析。治疗方法包括桡骨头置换术（RHA），切开复位内固定（ORIF）与金属植入物（ORIF-M），ORIF与生物可降解植入物（ORIF-B）和非手术管理。在我们对“良好”或“优秀”患者报告结局指标(PROMs)的网络荟萃分析中，RHA显著有利于ORIF-M（OR：0.04，CrI：0.0011，0.87），ORIF-B(OR:0.1CrI:0.00076,6.37)。非手术治疗未显示出比RHA明显更差（OR：0.01CrI：2.5e-0.5，3.61）。结论：这项网络荟萃分析表明，在移位的桡骨头骨折中，根据现有证据，RHA与功能明显优于ORIF-M的PROM相关。非手术治疗并未显着恶化。证据级别：III级（治疗）。
