旋前与旋后复位修复小儿桡骨头半脱位比较的Meta分析

摘要

背景：小儿桡骨头半脱位传统的复位方法多采用旋后复位法，近年发现，单纯的旋前复位法也可以取得良好的治疗效果。目的：通过Meta分析的方法比较旋前复位法与旋后复位法在治疗小儿桡骨头半脱位的效果。方法：由2名评价员检索中/英文公开发表的随机对照试验(RCT)。计算机检索the Cochrane Central Register of Controled Trials(CENTRAL)、PubMed、EMbase、the ISI Web of Knowledge Database、CNKI、CMB、VIP、万方数据库。检索时间均为建库时间至2015年1月31日。同时，手检纳入文献的参考文献。Meta分析采用Cochrane协作网提供的Rev-Man 5.3软件进行。结果与结论：共纳入5个研究，436例患者。Meta分析显示在有效性方面：旋前法组首次复位成功率明显高于旋后法组[RR=1.17，95%CI(1.08，1.28)，P=0.0003]；旋前法组最终复位失败率低于旋后法组[RR=0.25，95%CI(0.09，0.65)，P=0.005]；旋前法与旋后法在首次复位失败后采用相同手法第二次复位的成功率无差别[RR=1.39，95%CI(0.75，2.58)，P=0.30]。基于系统评价结果，采用GRADE系统推荐分级方法评价证据质量及推荐等级，结果显示：一次性复位成功率、最终复位失败率结局指标证据水平均为中级；首次复位失败后采用相同手法二次复位成功率结局指标证据水平为低级。提示旋前法与旋后法相比，在在首次复位成功率反面旋前法高于旋后法，最终复位失败率旋前法低于旋后法，首次复位失败后采用相同手法二次复位成功率方面二者无差异；但因原始研究质量不高，样本不大，建议临床上谨慎使用，尚需要更多高质量大样本的RCT进一步论证。%BACKGROUND:Supination maneuver is mainly used for reduction of radial head subluxation in children, but recently, pronation maneuver has also achieved good results in the treatment of radial head subluxation. OBJECTIVE:To objectively evaluate the efficacy of pronationversus supination maneuvers for the reduction of radial head subluxation by using Meta-analysis. METHODS:PubMed, Cochrane Central Register of Controled Trials (CENTRAL), EMbase, the ISI Web of Knowledge databases, VIP, CNKI, CBM and Wanfang were searched from database establishment to December 2014 for colecting the randomized controled trials (RCTs) about pronationversus supination maneuvers for the reduction of radial head subluxation, and the references of those RCTs were also searched by hand. After study selection, assessment and data extraction were conducted by two reviewers independently. Meta-analyses were performed by using the RevMan 5.2 software. RESULTS AND CONCLUSION:Five studies involving 436 patients were included. The results of Meta-analyses showed that: compared with the supination maneuvers group the pronation maneuvers group had a higher rate of successful reduction at the first attempt [RR=1.17, 95%CI (1.08, 1.28),P=0.000 3] and lower rate of failed reduction [RR=0.25, 95%CI(0.09, 0.65),P=0.005]. There was no significant difference in the rate of successful reduction at the second attempt [RR=1.39, 95%CI (0.75, 2.58),P=0.30]. Based on the results of systemic assessment, the level of evidence assessed by the GRADE system showed that the outcome indicators of the rate of successful reduction at the first attempt and rate of failed reduction were graded as intermediate level; the outcome indicator of the rate of successful reduction at the second attempt was graded as low level. For the poor quality of the original studies, a prudent choice is suggested; and more highly-quality, large-sample studies are needed.