背景:桡骨头骨折是成人肘部最常见的骨性损伤。目前的文献对孤立的稳定型II型桡骨头骨折是否应手术或非手术治疗不一致。本文旨在确定MasonII型桡骨头骨折的首选治疗方法,并比较保守治疗和手术治疗的结果。
方法:我们的研究使用了PRISMA指南,并对多个电子数据库进行了彻底的搜索,包括PubMed,科克伦,Embase,WebofScience,CNKI,和万方数据库,初步确定了545篇有关MasonII型桡骨头骨折的手术和保守治疗的相关出版物。这项研究的最终搜索日期是2024年7月7日。通过全面的荟萃分析,我们评估了几个结果,包括功能分数(DASH,OES,和MEPS分数),临床结果(肘部屈曲,肘部伸展缺陷,肘部内旋,和肘部旋光),和并发症发生率(总并发症和肘部疼痛)。比较了连续结局的平均差异(MD),比较了分类结局的比值比(ORs).
结果:共有来自4项研究的271名患者符合纳入标准。其中,142例患者接受手术治疗,129例患者接受非手术治疗。该研究发现DASH手术和非手术治疗之间没有统计学上的显着差异。OES,MEPS,肘部屈曲,肘关节伸展损伤,和肘部疼痛。与手术治疗相比,非手术治疗与较大的肘关节内旋相关(OR=-3.10,95%CI=[-4.96,-1.25],P=0.55,I2=0%)和较低的并发症发生率(OR=5.54,95%CI=[1.79,17.14],P=0.42,I2=0%)。
结论:根据目前的证据,孤立的MasonII桡骨头骨折的保守治疗可获得良好的治疗结果,且并发症发生率低.
BACKGROUND: Radial head fractures are the most common bony injury of the elbow in adults. The current literature does not agree on whether isolated stable type II radial head fractures should be treated operatively or nonoperatively. This review aims to determine the preferred treatment for Mason type II radial head fractures and compare the outcomes of conservative and surgical treatment.
METHODS: Our study used PRISMA guidelines and conducted a thorough search of multiple electronic databases, including PubMed, Cochrane, Embase, Web of Science, CNKI, and Wanfang databases, initially identifying 545 relevant publications on surgical and conservative treatment of Mason type II radial head fractures. The final search date for this study is July 7, 2024.Through a comprehensive meta-analysis, we evaluated several outcomes, including functional scores (DASH, OES, and MEPS scores), clinical outcomes (elbow flexion, elbow extension deficit, elbow pronation, and elbow supination), and complication rate (total complications and elbow pain). The mean difference (MD) was compared for continuous outcomes, and the odds ratios (ORs) were compared for categorical outcomes.
RESULTS: A total of 271 patients from 4 studies met the inclusion criteria. Among them, 142 patients received surgical treatment and 129 patients received non-surgical treatment. The study found no statistically significant differences between surgical and non-surgical treatments in DASH, OES, MEPS, elbow flexion, elbow extension impairment, and elbow pain. Compared with surgical treatment, non-surgical treatment was associated with greater elbow pronation (OR = -3.10, 95% CI = [-4.96, -1.25], P = 0.55, I2 = 0%) and a lower complication rate (OR = 5.54, 95% CI = [1.79, 17.14], P = 0.42, I2 = 0%).
CONCLUSIONS: Based on the current evidence, conservative management of isolated Mason II radial head fractures yields favorable therapeutic outcomes with a low incidence of complications.