儿童肱骨外髁骨折克氏针处理方式的Meta分析：暴露与埋藏？

A Meta Analysis of Kirschner Wires in Children with Lateral Humeral Condyle Fractures: Be Exposed or Buried?

摘要: 目的：通过Meta分析系统评价克氏针暴露和埋藏在儿童肱骨外髁骨折的安全性。方法：通过计算机检索中国知网、万方、维普、美国国立医学图书馆、考克兰图书馆、Web of Science等数据库，检索时间自建库至2024年12月国内外发表的有关克氏针暴露和埋藏治疗儿童肱骨外髁骨折的文献。根据设定的纳入与排除标准筛选文献并进行质量评价，使用RevMan5.3软件对两组在不良事件发生率、术后感染率、骨不愈合/延迟愈合率、非计划再手术率、拔针时间及肘关节功能优良率等方面进行统计分析。结果：共纳入7项研究738例患儿，暴露组288例，埋藏组450例。分析显示，相比于克氏针暴露组，克氏针埋藏组术后感染率更低[OR = 0.48, 95%CI (0.29, 0.78), P = 0.003]，克氏针埋藏组术后拔针时间较克氏针暴露组晚[OR = 19.11, 95%CI (4.38, 33.84), P = 0.01]。两组在不良事件发生率、骨不愈合/延迟愈合率、非计划再手术率及肘关节功能优良率比较，差异均无统计学意义(P > 0.05)。结论：对于未成年儿童肱骨外髁骨折，将克氏针埋藏于皮下感染率更低，克氏针在体内保留时间更长，拔除后无需额外石膏固定。并且埋藏克氏针能提高患儿舒适性便于术后护理。

Abstract: Objective: To compare the security of exposed versus buried Kirschner wires fixation in the treatment of lateral humeral condyle fractures in children. Methods: A systematic search was conducted in China National Knowledge Internet, Wanfang, VIP, PubMed, Cochrane library and Web of Science database from inception to December 2024. Studies comparing exposed and buried Kirschner wires in the treatment of lateral humeral condyle fractures in children were included. Outcome measures included and excluded by a set of inclusion and exclusion criteria and evaluated for their quality. The incidence of adverse events, postoperative infection rate, non-union/delayed union rate, unplanned re-operation rate, Kirschner wires removal time, and excellent elbow joint function rate were extracted and analyzed using software RevMan5.3. Results: 7 studies involving 738 patients were included, with 288 patients in the exposed group and 450 patients in the buried group. The infection rate in buried group was significantly lower than that in exposed group [OR = 0.48, 95%CI (0.29, 0.78), P = 0.003] according to the meta analysis. Buried Kirschner wires exhibit prolonged retention time in the body [OR = 19.11, 95%CI (4.38, 33.84), P = 0.01]. There was no variation in the incidence of adverse events, non-union/delayed union rate, unplanned re-operation rate, and elbow joint function between the two groups (P > 0.05). Conclusion: For lateral humeral condyle fractures, buried Kirschner wires had a lower infection rate than exposed, Kirschner wires exhibit prolonged retention time in the body and did not need additional plaster fixation is required after removal. Furthermore, buried Kirschner wires can improve the comfort of children and facilitate postoperative care.