TTIE中桡骨头骨折切开复位内固定与桡骨头置换疗效对比的Meta分析

doi:10.3877/cma.j.issn.2096-0263.2023.04.007

目的

通过这次Meta分析比较桡骨头置换与切开复位内固定在治疗肘关节恐怖三联征（TTIE）桡骨头骨折时疗效的差异。

方法

计算机检索自2013年3月至2022年3月在Pubmed、Web of Science、Embase、Cochrane Central Register of Controlled Trials （Central）、Cinahl、Medline、Cochrane Library、CBM、CNKI等数据库公开发表的切开复位内固定（ORIF）和假体置换（RHA）治疗TTIE中桡骨头骨折的文献，依据检索策略，共检索到相关文献1 141篇，并最终纳入12篇文献。根据Cochrane系统分析法，由两名评价员从纳入的研究中独立提取数据，并使用RevMan 5.4进行分析，并评估研究质量。

结果

通过Meta分析发现，手术治疗肘关节恐怖三联征时，RHA组术后前臂伸展活动度[95% CI（-5.53，-1.50），P<0.001]和术后并发症发生率[95% CI（0.20，0.79），P=0.008]上优于ORIF治疗的患者，差异有统计学意义。Mayo肘关节功能（MEPS）评分、上肢功能障碍评定量表（DASH）评分和旋转活动度方面二者比较差异无统计学意义。

结论

RHA组较ORIF组术后具有更优异的前臂伸展活动度和更少的术后并发症发生，因此在治疗肘关节恐怖三联征时，RHA优于ORIF。

关键词: 肘关节恐怖三联征, 人工桡骨头置换术, 桡骨头切开复位内固定术

Objective

The differences of efficacy between RHA and ORIF for the treatment of terrible triad injury of the elbow (TTIE) were compared in this Meta-analysis.

Methods

We searched the literatures published in databases such as Pubmed, Web of Science, Embase, Cochrane Central Register of Controlled Trials (Central), Cinahl, Medline, Cochrane Library, CBM, CNKI, etc., from March 2013 to March 2022. A total of 1, 141 related literatures were retrieved, and 12 literatures were finally included. Data from included studies were extracted independently by two reviewers, analysed using RevMan 5.4, and study quality was assessed according to Cochrane systematic analysis.

Results

On surgical treatment for TTIE, we found that forearm extension range of motion after surgery in RHA group [95% CI: -5.53, -1.50, P<0.001] was superior to ORIF, with lower incidence of complications [95% CI: 0.20, 0.79, P<0.001], and the difference was statistically significant. Meanwhile, there was no statistically significant difference in terms of Mayo Elbow Performance Score (MEPS) Score, Disabilities of the Arm, Shoulder and Hand (DASH) Score and elbow range of motion (flexion–extension arc).

Conclusions

Compared with the ORIF, the RHA group had better forearm extension range of motion and fewer complications after surgery, so RHA was superior to ORIF in the treatment of TTIE.

Key words: Terrible triad injury of the elbow, Radial head arthroplasty, Open reduction internal fixation

图1 文献筛选流程图

表1 纳入文献研究基本特征表

作者	研究性质	国家	发表年份	组别	病例数	年龄/岁	性别比（男/女）	结局指标	改良Jadad评分
Aff等^[8]	前瞻性	埃及	2020	RHA	16	40.4±14.9	17/13	⑴⑵⑶	6
Aff等^[8]	前瞻性	埃及	2020	ORIF	14	40.4±14.9	17/13	⑴⑵⑶	6
Giannicola等^[9]	前瞻性	意大利	2015	RHA	16	53.13±12.49 48.89±20.25	7/9	⑴⑵⑶⑷	6
Giannicola等^[9]	前瞻性	意大利	2015	ORIF	9	53.13±12.49 48.89±20.25	5/4	⑴⑵⑶⑷	6
Hou等^[10]	回顾性	中国	2020	RHA	3	37.33±5.86 33.81±7.30	1/2	⑴⑵⑶⑷	4
Hou等^[10]	回顾性	中国	2020	ORIF	21	37.33±5.86 33.81±7.30	15/6	⑴⑵⑶⑷	4
Klug等^[11]	回顾性	德国	2020	RHA	26	53.9±43.57	8/18	⑴⑵⑶	4
Klug等^[11]	回顾性	德国	2020	ORIF	51	-	-	⑴⑵⑶	4
Li等^[12]	回顾性	中国	2018	RHA	24	37.5±75.63	34/20	⑴⑷	4
Li等^[12]	回顾性	中国	2018	ORIF	30	37.5±75.63	34/20	⑴⑷	4
Liu等^[13]	回顾性	中国	2018	RHA	4	48.23±10.95	29/12	⑴⑶⑷	4
Liu等^[13]	回顾性	中国	2018	ORIF	37	48.23±10.95	29/12	⑴⑶⑷	4
Matar等^[14]	回顾性	英国	2017	RHA	9	55.67±8.56	4/5	⑴⑶⑷	5
Matar等^[14]	回顾性	英国	2017	ORIF	4	61.5±12.26	0/4	⑴⑶⑷	5
Pierrart等^[15]	回顾性	法国	2015	RHA	7	-	-	⑴⑶	3
Pierrart等^[15]	回顾性	法国	2015	ORIF	10	-	-	⑴⑶	3
Watters等^[16]	回顾性	美国	2014	RHA	30	48±64.49	21/18	⑶	2
Watters等^[16]	回顾性	美国	2014	ORIF	9	48±64.49	21/18	⑶	2
Yan等^[17]	回顾性	中国	2015	RHA	20	36.54±6.58	11/9	⑴⑶⑷	6
Yan等^[17]	回顾性	中国	2015	ORIF	19	35.51±6.28	7/12	⑴⑶⑷	6
Zhang等^[18]	回顾性	中国	2014	RHA	2	-	-	⑴⑶⑷	5
Zhang等^[18]	回顾性	中国	2014	ORIF	18	-	-	⑴⑶⑷	5
Zheng等^[19]	回顾性	中国	2020	RHA	13	47.08±6.20	9/4	⑴	3
Zheng等^[19]	回顾性	中国	2020	ORIF	10	48.20±7.22	6/4	⑴	3

表1 纳入文献研究基本特征表

作者	研究性质	国家	发表年份	组别	病例数	年龄/岁	性别比（男/女）	结局指标	改良Jadad评分
Aff等^[8]	前瞻性	埃及	2020	RHA	16	40.4±14.9	17/13	⑴⑵⑶	6
Aff等^[8]	前瞻性	埃及	2020	ORIF	14	40.4±14.9	17/13	⑴⑵⑶	6
Giannicola等^[9]	前瞻性	意大利	2015	RHA	16	53.13±12.49 48.89±20.25	7/9	⑴⑵⑶⑷	6
Giannicola等^[9]	前瞻性	意大利	2015	ORIF	9	53.13±12.49 48.89±20.25	5/4	⑴⑵⑶⑷	6
Hou等^[10]	回顾性	中国	2020	RHA	3	37.33±5.86 33.81±7.30	1/2	⑴⑵⑶⑷	4
Hou等^[10]	回顾性	中国	2020	ORIF	21	37.33±5.86 33.81±7.30	15/6	⑴⑵⑶⑷	4
Klug等^[11]	回顾性	德国	2020	RHA	26	53.9±43.57	8/18	⑴⑵⑶	4
Klug等^[11]	回顾性	德国	2020	ORIF	51	-	-	⑴⑵⑶	4
Li等^[12]	回顾性	中国	2018	RHA	24	37.5±75.63	34/20	⑴⑷	4
Li等^[12]	回顾性	中国	2018	ORIF	30	37.5±75.63	34/20	⑴⑷	4
Liu等^[13]	回顾性	中国	2018	RHA	4	48.23±10.95	29/12	⑴⑶⑷	4
Liu等^[13]	回顾性	中国	2018	ORIF	37	48.23±10.95	29/12	⑴⑶⑷	4
Matar等^[14]	回顾性	英国	2017	RHA	9	55.67±8.56	4/5	⑴⑶⑷	5
Matar等^[14]	回顾性	英国	2017	ORIF	4	61.5±12.26	0/4	⑴⑶⑷	5
Pierrart等^[15]	回顾性	法国	2015	RHA	7	-	-	⑴⑶	3
Pierrart等^[15]	回顾性	法国	2015	ORIF	10	-	-	⑴⑶	3
Watters等^[16]	回顾性	美国	2014	RHA	30	48±64.49	21/18	⑶	2
Watters等^[16]	回顾性	美国	2014	ORIF	9	48±64.49	21/18	⑶	2
Yan等^[17]	回顾性	中国	2015	RHA	20	36.54±6.58	11/9	⑴⑶⑷	6
Yan等^[17]	回顾性	中国	2015	ORIF	19	35.51±6.28	7/12	⑴⑶⑷	6
Zhang等^[18]	回顾性	中国	2014	RHA	2	-	-	⑴⑶⑷	5
Zhang等^[18]	回顾性	中国	2014	ORIF	18	-	-	⑴⑶⑷	5
Zheng等^[19]	回顾性	中国	2020	RHA	13	47.08±6.20	9/4	⑴	3
Zheng等^[19]	回顾性	中国	2020	ORIF	10	48.20±7.22	6/4	⑴	3

图4 RHA与ORIF治疗肘关节恐怖三联征术后肘关节活动度的Meta分析

图8 发表偏倚漏斗（注：图a MEPS评分；b DASH评分；c术后肘关节活动度；d术后并发症）

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[1]	唐晓俞, 王志刚. 陈旧性肘关节恐怖三联征伴关节僵硬的手术治疗[J]. 中华肩肘外科电子杂志, 2020, 08(01): 43-50.

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Radial head arthroplasty versus Open reduction and internal fixation for the treatment of the terrible triad injury of the elbow: a systematic review and Meta-analysis

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Radial head arthroplasty versus Open reduction and internal fixation for the treatment of the terrible triad injury of the elbow: a systematic review and Meta-analysis