可吸收材料及克氏针内固定治疗儿童肱骨外髁骨折疗效的Meta分析

摘要

背景:目前尚无确切的循证医学证据证明,可吸收材料在治疗儿童肱骨外髁骨折方面的优势或不足.目的:通过Meta分析系统评价切开复位可吸收材料内固定与克氏针内固定治疗儿童肱骨外髁骨折的临床疗效.方法:检索万方数据库、维普数据库、CNKI数据库、中国生物医学文献数据库、EMbase、PubMed等数据库,收集包括切开复位可吸收材料内固定与克氏针内固定治疗儿童肱骨外髁骨折的对照试验,提取数据,进行质量评价,并通过RevMan5.3软件进行系统评价,比较两组术后肘关节功能恢复情况、平均住院费用差异、总的不良事件发生情况、术后骨折延迟愈合发生情况、术后感染、神经损伤及肘部畸形等差异.结果与结论:共纳入7篇文献,涉及449例儿童肱骨外髁骨折患者,试验组采用可吸收材料进行内固定治疗,对照组采用克氏针进行内固定治疗.Meta分析结果显示,试验组与对照组术后肘关节功能恢复、术后骨折延迟愈合发生、肘部畸形发生方面比较差异无显著性意义[OR=0.72,95％CI(0.37,1.41),P=0.34;OR=0.46,95％CI(0.16,1.30),P=0.14;OR=0.70,95％CI(0.24,2.10),P=0.53],试验组总的不良事件、术后感染发生情况少于对照组[OR=0.17,95％CI(0.08,0.38),P<0.0001;OR=0.09,95％CI(0.02,0.38),P=0.001],两组平均住院费用及神经损伤指标暂无可比性,尚需更多临床研究得出结论.结果表明与克氏针内固定治疗相比,可吸收材料内固定治疗儿童肱骨外髁骨折的效果并不差,而预防不良事件及术后感染方面的效果更好.以上结论需要更多大样本、双盲、高质量的随机对照研究加以论证.%BACKGROUND:Currently, there is no explicit evidence-based medicine evidence to prove the merits or demerits of absorbable materials in the treatment of fractures of the lateral humeral condyle in children. OBJECTIVE:To evaluate the clinical efficacies of open reduction with absorbable material versus open reduction with Kirschner wire fixation for lateral condylar fracture of the humerus in children.METHODS:WanFang, VIP, CNKI, CBMdisc, EMbase, PubMed were retrieved for controlled trials concerning open reduction with absorbable material versus open reduction with Kirschner wire fixation for treating lateral condylar fracture of the humerus in children. After data extraction and quality evaluations, RevMan 5.3 software was used for systematic review. Postoperative functional recovery of the elbow joint, average hospitalization expenses, adverse events, delayed union, postoperative infection, nerve injury and deformity of the elbow were compared in patients undergoing different treatments. RESULTS AND CONCLUSION:A total of seven articles, involving 449 children with lateral condylar fracture of the humerus, were included for this Meta-analysis. Children in test group received open reduction with absorbable material, while those in control group were subjected to open reduction with Kirschner wire fixation. For treating lateral condylar fracture of the humerus in children, no significant inter-group difference existed in the aspects of postoperative functional recovery of the elbow joint [odds ratio (OR)=0.72, 95％ confidence interval (CI) (0.37, 1.41),P=0.34]; postoperative delayed union [OR=0.46, 95％CI(0.16, 1.30),P=0.14]; deformity of the elbow [OR=0.70, 95％CI (0.24, 2.10),P=0.53]. Less adverse events and postoperative infections were observed in the test group compared with the control group [OR=0.17, 95％CI (0.08, 0.38),P < 0.0001;OR=0.09, 95％CI (0.02, 0.38),P=0.001]. However, up to now, we knew of no comparable data concerning average hospitalization expenses and indicators for nerve injury between the two groups. To conclude, compared with Kirschner wire fixation, open reduction with absorbable material can achieve similar effects on lateral condylar fractures of the humerus, but has better effects to prevent adverse events and postoperative infection. Further investigation on large-scale, double-blind, high-quality randomized controlled trials is warranted for confirming our results.