背景:肱骨外髁骨折是儿童中第二常见的肘部骨折。非移位的外侧髁骨折通常可以通过石膏和保守治疗来治疗。而复位固定常用于治疗移位的外侧髁骨折。传统上,克氏针固定已用于移位的外侧髁骨折,但是最近一些研究提倡使用螺钉固定。因此,我们进行了一项荟萃分析,以确定两种不同固定方法治疗小儿肱骨外髁移位骨折的结局和并发症的差异.
方法:本综述使用系统评价和荟萃分析(PRISMA)指南的首选报告项目。PubMed,Embase,和Cochrane文库用于研究选择。包括比较K线和螺钉固定在小儿移位的外侧髁骨折中的研究。使用Hardacre标准的临床结果,感染,肘部运动范围的限制,外侧髁过度生长,延迟工会,骨不连,并对缺血性坏死进行比较。使用R版本4.2.2中的meta包分析数据,并根据异质性使用随机效应或固定效应模型。
结果:纳入一项随机对照研究和三项回顾性队列研究,共有240名患者(K线:118,螺钉:122)。使用Hardacre标准的临床结果在两组之间没有差异(P=0.54),但感染风险(风险比[RR]=5.52,95%CI:1.42-21.48,P=0.01)和活动范围受限(RR=3.75,95%CI:1.54-9.18,P<0.01)明显高于螺钉固定组。
结论:在儿童肱骨外髁骨折复位后使用螺钉固定与使用K-wire相比,降低了浅表感染和肘部僵硬的风险。尽管在全身麻醉下摘除植入物是必要的,对于移位的儿童肱骨外髁骨折,可以考虑采用螺钉内固定。
背景:PROSPERO(CRD42023415643)。
BACKGROUND: Lateral condyle fracture of the humerus is the second most common elbow fracture in children. Non-displaced lateral condyle fractures can often be managed with cast and conservative care, while reduction and fixation are often used to treat displaced lateral condyle fractures. Traditionally, K-wire fixation has been used for displaced lateral condyle fractures, but recently fixation using screws has been advocated in some studies. Therefore, we performed a meta-analysis to determine the difference in outcomes and complications between the two different fixation methods for the treatment of displaced lateral condyle fractures of the humerus in pediatric patients.
METHODS: Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines were used for this
review. PubMed, Embase, and Cochrane Library were used for study selection. Studies comparing K-wires and screw fixation in displaced lateral condyle fractures in pediatric patients were included. Clinical outcomes using the Hardacre criteria, infection, limitation of range of motion of the elbow, lateral condyle overgrowth, delayed union, nonunion, and avascular necrosis were compared. Data were analyzed using the meta package in R version 4.2.2, and random-effects or fixed-effects models were used according to heterogeneity.
RESULTS: One randomized controlled study and three retrospective cohort studies were included, with a total of 240 patients (K-wire:118, screw:122). The clinical outcome using the Hardacre criteria was not different between the groups (P = 0.54), but the risk of infection (risk ratio [RR] = 5.52, 95% CI: 1.42-21.48, P = 0.01) and limitation of range of motion (RR = 3.75, 95% CI: 1.54-9.18, P < 0.01) were significantly higher in the K-wire fixation group than in screw fixation group.
CONCLUSIONS: The use of screws for fixation after reduction in the treatment of lateral condyle fracture of the humerus in children decreases the risk of superficial infection and elbow stiffness compared with the use of K-wire. Although removal of the implant under general anesthesia is necessary, screw fixation can be considered in displaced lateral condyle fractures of the humerus in children.
BACKGROUND: PROSPERO (CRD42023415643).