Ulna Extending Osteotomy Surgery With Annual Ligament Reconstruction For The Treatment Of Obsolete Monteggia Fractures In Children: A Meta-analysis

Background :Ulnar extending osteotomy surgery has been widely used to treat childhood obsolete Monteggia fractures,And annular ligament has usually been reconstructed to stabilize the reduction of the radial head during surgery,But in recent years,with the increase in surgical cases and clinical long-term follow-up data,ligament reconstruction related issues have begun to expose,there are many intraoperative and postoperative complications,and the reconstruction process is too cumbersome,surgical trauma.The study found that some of the children without annual ligament reconstruction can also get a good effect after surgery.Although intraoperative no annular ligament reconstruction on the efficacy of obsolete Monteggia fractures has been reported in the literature,but its effectiveness is still unclear,the current study is mostly small sample study,and the conclusions are not the same,so it is difficult to get the best evidence,higher sample size,higher evidence-based evidence-based medical methods are required for comparison.Objective :To evaluate the effect of ulnar extending osteotomy with or without annual ligament reconstruction for the treatment of obsolete Monteggia fracture in children with meta-analysis.Methods : The Pub Med database,CBM database,CNLI database and Wanfang database were searched by compute from the storage to October2016,and related Journals were manually searched.Collect all randomized,retrospective clinical cohort studies relevant literature which using ulna extending osteotomy to treat the obsolete Montaggia fracture in children,and to compare the operative effect with or without annular ligament reconstruction,and to do the methodological evaluation of the included research.The main contents of the comparison include :postoperative elbow rotation limited incidence,postoperative elbow flexion and extension limited incidence,postoperative radial head dislocation incidence and the incidence of radial head thinning rate.Using the Rev Man 5.3 software provided by the Cochrane Collaboration Network to perform the statistical analysis.Result : Five relevant studies were included,Four of them were retrospective cohort studies and one prospective cohort study,Meta analysis showed that the incidence of postoperative rotation of the elbow was significantly higher in the reconstruction group than in the non-reconstructed group(p=0.006,RR=1.82,95%CI=1.19,2.79),there was significant difference between the two groups,there was no significant difference in the incidence of flexion and extension(p=0.08,RR=1.77,95%CI=0.93,3.37),the incidence of radial head dislocation(p=0.66,RR=0.69,95%CI=0.14,3.56),and the incidence of radial head turns thinner(p=0.07,RR=7.00,95%CI=0.88,55.46)between the reconstruction group and the non-reconstructed group.Because the postoperative elbow score is based on different evaluation methods,it has no meta-analysis,only for a brief description.Conclusion : The available evidence shows that ulnar extending osteotomy surgery without annular ligament reconstruction in the treatment of children with obsolete Monteggia fracture after surgery was significantly better than the reconstruction group,and the former can significantly reduce the incidence of postoperative elbow rotation limited.But,long-term efficacy is still large sample,multi-center study to further verify.