【摘要】 目的系统评价旋前和旋后两种手法复位儿童桡骨小头半脱位的效果。方法计算机检索PubMed、The Cochrane Library、EMbase、CBM、CNKI、VIP和万方等数据库,查找相关随机对照试验,检索时限均从建库至2014-07月。按纳入与排除标准筛选文献、提取数据和评价纳入研究的方法质量后,采用RevMan 5.3.1软件进行Meta分析。结果共纳入6个研究,551名患儿,年龄均小于7周岁。所纳入的6个研究均采用旋前和旋后两种手法复位比较,1个研究由于没有进行分配隐藏有高度偏移的风险,6个研究由于都没有对测量者实施盲法有测量偏移风险。结果提示旋前手法复位明显优于旋后复位[RR=0.40,95%CI(0.26,0.61)]。其中3个研究报道了复位过程中的疼痛评分,由于评分标准不同没有进行Meta分析,3个研究都认为旋前手法比旋后手法疼痛要小。结论小样本、低质量的证据表明旋前手法复位比旋后手法复位更有效,疼痛也更小。建议进一步行大样本、高质量的随机对照试验进一步验证结论。更多还原

【Abstract】 Objective To compare the effectiveness and painfulness of different methods used to manipulate pulled elbow in children.Methods Clinical trial registers and reference lists of articles was retrieved in Cochrane Bone,Joint and Muscle Trauma Group Specialised Register,the Cochrane Central Register of Controlled Trials,MEDLINE,EMBASE,CINAHL,LILACS,PEDro,CNKI,VIP and WangFang and the date of last retrieval was July 2014.Trails were evaluated by two review authors independently for inclusion,and for the included trials,risk of bias and extracted data were independently assessed.Results Six trials with 551 children,all younger than seven years old,were included,and all six trials were compared pronation versus supination.One trial was at high risk of selection bias because allocation was not concealed and all four trials were at high risk of detection bias due to the lack of assessor blinding.Pronation resulted in statistical significance with less failure than that of supination(risk ratio0.40;95%confidence interval 0.26 to 0.61).Pain perception was reported by three trials but data were unavailable for pooling.Both studies concluded that the pronation technique was less painful than that of supination technique.Conclusion There is evidence from six small low-quality trials showing that the pronation method might be more effective and less painful than that of supination method for manipulating pulled elbow in children.It is recommended that a high quality randomised trial can be performed to strengthen the evidence.更多还原