尺骨截骨矫形术结合环状韧带重建治疗儿童陈旧性孟氏骨折的meta分析

发布时间：2018-05-01 00:10

本文选题：儿童 + 陈旧性孟氏骨折　；参考：《吉林大学》2017年硕士论文

【摘要】：背景:尺骨截骨延长矫形术已广泛用于治疗儿童陈旧性孟氏骨折,并且之前术中往往行环状韧带重建以稳定复位后的桡骨头,但近些年来,随着手术病例和临床长期随访资料的增加,韧带重建的相关问题也开始暴露出来,其术中及术后并发症较多,且重建过程过于繁琐,手术创伤大。研究发现术中不行环状韧带重建的部分患儿,术后亦可取得很好的疗效。尽管对于术中不行环状韧带重建对陈旧性孟氏骨折术后的疗效影响已有多篇文献报道,但其有效性依然不明确,当前的研究中多为小样本研究,且各研究结论也不尽相同,因此很难获得最佳证据,需要样本量大、证据等级更高的循证医学方法进行比较。目的:对尺骨截骨延长矫形术结合或不结合环状韧带重建治疗儿童陈旧性孟氏骨折的疗效进行meta分析。方法:计算机检索从建库至2016年10月的Pubmed、CBM、CNKI和万方数据库相关文章,并手工检索相关中文杂志。收集所有采用尺骨截骨延长术治疗儿童陈旧性孟氏骨折,并比较术中行环状韧带重建与不行环状韧带重建临床疗效的所有随机对照、回顾性临床队列研究的相关文献,并对纳入的研究进行方法学质量评价。比较内容主要包括:术后肘关节旋转受限发生率,术后肘关节屈伸受限发生率、桡骨小头再脱位发生率及桡骨小头变细发生率,利用Cochrane协作网提供的Rev Man 5.3软件进行统计学分析。结果:最终纳入相关研究5篇,其中4篇为回顾性队列研究,1篇前瞻性队列研究。Meta分析结果显示,重建组术后肘关节旋转受限发生率明显高于非重建组(P=0.006,RR=1.82,95%CI=1.19,2.79),两组间差异有统计学意义;重建组与非重建组的肘关节屈伸受限发生率(P=0.08,RR=1.77,95%CI=0.93,3.37)、桡骨小头再脱位发生率(P=0.66,RR=0.69,95%CI=0.14,3.56)及桡骨小头变细发生率(P=0.07,RR=7.00,95%CI=0.88,55.46)无统计学差异。由于术后肘关节评分采用不同的评比方法,未对其进行meta分析,仅作简单描述。结论:现有证据表明,尺骨截骨延长矫形术时不行环状韧带重建在治疗儿童陈旧性孟氏骨折的术后疗效明显优于重建组,并且前者可明显减少术后肘关节旋转受限的发生率。但远期疗效仍需要大样本、多中心的随机对照研究进一步验证。
[Abstract]:Background: ulnar osteotomy and lengthening orthopedics have been widely used in the treatment of old Monteggia fractures in children, and the annular ligament reconstruction has been performed in previous operations to stabilize the reduction of the radial head, but in recent years, With the increase of operation cases and long-term clinical follow-up data, the problems related to ligamentous reconstruction began to be exposed. There were more complications during and after the operation, and the reconstruction process was too cumbersome and the surgical trauma was great. It was found that some of the children who failed to reconstruct the annular ligament during operation could also get good results after operation. Although there have been many reports on the effect of intraoperative reconstruction of annular ligament on the curative effect of the old Monteggia fracture, its validity is still unclear, and the current studies are mostly small sample studies, and the conclusions of each study are different. Therefore, it is difficult to obtain the best evidence. Objective: to analyze the effect of extended ulnar osteotomy combined with or without annular ligament reconstruction in the treatment of old Monteggia fracture in children by meta. Methods: the relevant articles of Pubmedus CBMNKI and Wanfang database were searched by computer from the establishment of the database to October 2016, and the relevant Chinese journals were searched manually. To collect all the randomized controls for the treatment of old Monteggia fracture in children by ulnar osteotomy and lengthening, and to compare the clinical efficacy of annular ligament reconstruction with that of non-circular ligament reconstruction, and to review the literature of clinical cohort study. The methodological quality of the included research was evaluated. The main contents of the comparison include: the incidence of postoperative elbow rotation limitation, postoperative elbow joint flexion and extension limitation, the incidence of radial head redislocation and the incidence of radial head thinning. Using the Rev Man 5.3 software provided by Cochrane cooperation network to carry on the statistical analysis. Results: five related studies were included, of which 4 were retrospective cohort studies and 1 prospective cohort study. Meta-analysis showed that, The incidence of limited rotation of elbow joint in the reconstruction group was significantly higher than that in the non-reconstruction group (P < 0.006). There was no significant difference in the incidence of elbow flexion and extension limitation between the reconstruction group and the non-reconstruction group. There was no significant difference in the incidence of elbow joint flexion and extension between the reconstruction group and the non-reconstruction group. There was no significant difference between the two groups. Due to the different evaluation methods of elbow joint after operation, meta analysis was not carried out, only a simple description was made. Conclusion: the available evidence shows that the reconstruction of annular ligament during ulnar osteotomy and orthopedics is superior to that in the reconstruction group in the treatment of old Monteggia fracture in children, and the former can significantly reduce the incidence of limited rotation of elbow joint after operation. But long-term outcomes still require large samples to be further validated by a multi-center randomized controlled study.
【学位授予单位】：吉林大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R726.8

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