本文選題：兒童 + 陳舊性孟氏骨折�。� 參考：《吉林大學(xué)》2017年碩士論文

【摘要】：背景:尺骨截骨延長(zhǎng)矯形術(shù)已廣泛用于治療兒童陳舊性孟氏骨折,并且之前術(shù)中往往行環(huán)狀韌帶重建以穩(wěn)定復(fù)位后的橈骨頭,但近些年來(lái),隨著手術(shù)病例和臨床長(zhǎng)期隨訪資料的增加,韌帶重建的相關(guān)問(wèn)題也開(kāi)始暴露出來(lái),其術(shù)中及術(shù)后并發(fā)癥較多,且重建過(guò)程過(guò)于繁瑣,手術(shù)創(chuàng)傷大。研究發(fā)現(xiàn)術(shù)中不行環(huán)狀韌帶重建的部分患兒,術(shù)后亦可取得很好的療效。盡管對(duì)于術(shù)中不行環(huán)狀韌帶重建對(duì)陳舊性孟氏骨折術(shù)后的療效影響已有多篇文獻(xiàn)報(bào)道,但其有效性依然不明確,當(dāng)前的研究中多為小樣本研究,且各研究結(jié)論也不盡相同,因此很難獲得最佳證據(jù),需要樣本量大、證據(jù)等級(jí)更高的循證醫(yī)學(xué)方法進(jìn)行比較。目的:對(duì)尺骨截骨延長(zhǎng)矯形術(shù)結(jié)合或不結(jié)合環(huán)狀韌帶重建治療兒童陳舊性孟氏骨折的療效進(jìn)行meta分析。方法:計(jì)算機(jī)檢索從建庫(kù)至2016年10月的Pubmed、CBM、CNKI和萬(wàn)方數(shù)據(jù)庫(kù)相關(guān)文章,并手工檢索相關(guān)中文雜志。收集所有采用尺骨截骨延長(zhǎng)術(shù)治療兒童陳舊性孟氏骨折,并比較術(shù)中行環(huán)狀韌帶重建與不行環(huán)狀韌帶重建臨床療效的所有隨機(jī)對(duì)照、回顧性臨床隊(duì)列研究的相關(guān)文獻(xiàn),并對(duì)納入的研究進(jìn)行方法學(xué)質(zhì)量評(píng)價(jià)。比較內(nèi)容主要包括:術(shù)后肘關(guān)節(jié)旋轉(zhuǎn)受限發(fā)生率,術(shù)后肘關(guān)節(jié)屈伸受限發(fā)生率、橈骨小頭再脫位發(fā)生率及橈骨小頭變細(xì)發(fā)生率,利用Cochrane協(xié)作網(wǎng)提供的Rev Man 5.3軟件進(jìn)行統(tǒng)計(jì)學(xué)分析。結(jié)果:最終納入相關(guān)研究5篇,其中4篇為回顧性隊(duì)列研究,1篇前瞻性隊(duì)列研究。Meta分析結(jié)果顯示,重建組術(shù)后肘關(guān)節(jié)旋轉(zhuǎn)受限發(fā)生率明顯高于非重建組(P=0.006,RR=1.82,95%CI=1.19,2.79),兩組間差異有統(tǒng)計(jì)學(xué)意義;重建組與非重建組的肘關(guān)節(jié)屈伸受限發(fā)生率(P=0.08,RR=1.77,95%CI=0.93,3.37)、橈骨小頭再脫位發(fā)生率(P=0.66,RR=0.69,95%CI=0.14,3.56)及橈骨小頭變細(xì)發(fā)生率(P=0.07,RR=7.00,95%CI=0.88,55.46)無(wú)統(tǒng)計(jì)學(xué)差異。由于術(shù)后肘關(guān)節(jié)評(píng)分采用不同的評(píng)比方法,未對(duì)其進(jìn)行meta分析,僅作簡(jiǎn)單描述。結(jié)論:現(xiàn)有證據(jù)表明,尺骨截骨延長(zhǎng)矯形術(shù)時(shí)不行環(huán)狀韌帶重建在治療兒童陳舊性孟氏骨折的術(shù)后療效明顯優(yōu)于重建組,并且前者可明顯減少術(shù)后肘關(guān)節(jié)旋轉(zhuǎn)受限的發(fā)生率。但遠(yuǎn)期療效仍需要大樣本、多中心的隨機(jī)對(duì)照研究進(jìn)一步驗(yàn)證。
[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.
【學(xué)位授予單位】：吉林大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2017
【分類號(hào)】：R726.8

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