背景:复杂肘部骨折脱位,一个或几个周围骨稳定剂断裂的位错,难以管理,并与不良结果相关。虽然许多研究已经探索了治疗策略,但缺乏患者报告的结果测量(PROM)的标准化使得跨研究比较困难。在这次系统审查中,我们的目的是描述什么伤害模式,衡量的结果,复杂的肘关节骨折脱位文献报道了相关并发症,以提供结局报告建议,有助于改善未来的跨研究比较.
方法:根据PRISMA指南进行系统评价。我们查询了PubMed/MEDLINE,Embase,WebofScience,和Cochrane数据库,以确定2010年至2022年之间发表的有关复杂肘关节骨折脱位的成年患者的文章。排除病理性骨折。使用非随机研究标准的方法学指标进行偏倚评估。对于每一篇文章,患者人口统计学,损伤模式,结果衡量标准,并记录并发症。
结果:91项研究报告了3664个肘部骨折和脱位(加权平均年龄44岁,随访30个月,41%的女性)进行了评估。其中,在3378个肘部中描述了损伤模式,包括2951个(87%)可怕的三联征损伤和72个(2%)跨鹰嘴骨折脱位。三种最常报道的分类系统是:桡骨头骨折的梅森分类,Regan和Morrey冠骨骨折的冠骨分类,冠状突骨折的O\'Driscoll分类。在87(96%)研究中报告了运动范围,其中大多数报告了屈曲(n=70),扩展(n=62),内翻(n=68),或旋后(n=67)。在11项(12%)研究中报告了强度。在83项(91%)研究中报告了PROM,平均每项研究有2.6个结果。有14个结果得分,包括梅奥肘部表现得分(MEPS)(n=69[83%]),手臂的残疾,肩和手(DASH)得分(n=28[34%]),疼痛视觉模拟量表(VAS)(n=27[33%]),QuickDASH得分(n=13[15.7%]),和牛津肘得分(n=5[6.0%])。每篇文章使用的PROM数量和出版年份之间没有发现显著性(P=.313),研究类型(P=.689),复杂断裂模式(P=.211),或包括的弯头数量(P=.152)。
结论:报道的复杂肘关节骨折脱位文献中的PROM存在很大的异质性。尽管没有评估复杂肘部骨折脱位的黄金标准,我们建议在未来的研究中至少使用MEPS和DASH结局指标以及VAS疼痛评定量表,以促进跨研究比较.
BACKGROUND: Complex elbow fracture dislocations, dislocation with fracture of one or several surrounding bony stabilizers, are difficult to manage and associated with poor outcomes. While many studies have explored treatment strategies but a lack of standardization of patient-reported outcome measures (PROMs) makes cross-study comparison difficult. In this systematic
review, we aim to describe what injury patterns, measured outcomes, and associated complications are reported in the complex elbow fracture dislocation literature to provide outcome reporting recommendations that will facilitate improved future cross-study comparison.
METHODS: A systematic
review was performed per Preferred Reporting Items for Systematic reviews and Meta-Analyses guidelines. We queried PubMed/MEDLINE, Embase, Web of Science, and Cochrane databases to identify articles published between 2010 and 2022 reporting on adult patients who had a complex elbow fracture dislocation. Pathologic fractures were excluded. A bias assessment using the methodological index for nonrandomized studies criteria was conducted. For each article, patient demographics, injury pattern, outcome measures, and complications were recorded.
RESULTS: Ninety-one studies reporting on 3664 elbows (3654 patients) with an elbow fracture and dislocation (weighted mean age 44 years, follow-up of 30 months, 41% female) were evaluated. Of these, the injury pattern was described in 3378 elbows and included 2951 (87%) terrible triad injuries and 72 (2%) transolecranon fracture-dislocations. The three most commonly reported classification systems were: Mason classification for radial head fractures, Regan and Morrey coronoid classification for coronoid fractures, and O\'Driscoll classification for coronoid fractures. Range of motion was reported in 87 (96%) studies with most reporting flexion (n = 70), extension (n = 62), pronation (n = 68), or supination (n = 67). Strength was reported in 11 (12%) studies. PROMs were reported in 83 (91%) studies with an average of 2.6 outcomes per study. There were 14 outcome scores including the Mayo Elbow Performance Score (n = 69 [83%]), the Disabilities of Arm, Shoulder and Hand (DASH) score (n = 28 [34%]), the visual analog scale for pain (n = 27 [33%]), QuickDASH score (n = 13 [15.7%]), and Oxford Elbow score (n = 5 [6.0%]). No significance was found between the number of PROMs used per article and the year of publication (P = .313), study type (P = .689), complex fracture pattern (P = .211), or number of elbows included (P = .152).
CONCLUSIONS: There is great heterogeneity in reported PROMs in the complex elbow fracture dislocation literature. Although there is no gold standard PROM for assessing complex elbow fracture dislocations, we recommend the use of at least the Mayo Elbow Performance Score and DASH outcomes measures as well as visual analog scale pain rating scale in future studies to facilitate cross-study comparisons.