9 33 05 08 3 Chinese Journal of Tissue Engineering Research August 3, 05 Vol.9, No.33 Meta ( 3007) Meta Meta Meta /(RCT) the Cochrane Central Register of Controlled Trials(CENTRAL) PubMed EMbase the ISI Web of Knowledge Database CNKI CMB VIP 05 3 Meta Cochrane Rev-Man 5.3 5 36 Meta : [RR=.7 95%CI(.08.8) P=0.000 3] [RR=0.5 95%CI(0.09 0.65) P=0.005] [RR=.39 95%CI(0.75.58) P=0.30] GRADE RCT 99 :R38 :B :095-3 (05)33-050-06 05-06-09 http://www.crter.org. Meta [J]. 05 9(33):50-507. doi:0.3969/j.issn.095-3.05.33.08 Pronation versus supination maneuvers for the reduction of radial head subluxation: A Meta-analysis Feng Fan, Deng Zhou-ming, Ran Bing, Xie Yuan-long, Ruan Wen-feng, Cai Lin (Fourth Department of Orthopedics, Zhongnan Hospital of Wuhan University, Wuhan 3007, Hubei Province, China) Abstract BACKGROUND: Supination maneuver is mainly used for reduction of radial head subluxation in children, but recently, pronation maneuver has also achieved good results in the treatment of radial head subluxation. OBJECTIVE: To objectively evaluate the efficacy of pronation versus supination maneuvers for the reduction of radial head subluxation by using Meta-analysis. METHODS: PubMed, Cochrane Central Register of Controlled Trials (CENTRAL), EMbase, the ISI Web of Knowledge databases, VIP, CNKI, CBM and Wanfang were searched from database establishment to December 0 for collecting the randomized controlled trials (RCTs) about pronation versus supination maneuvers for the reduction of radial head subluxation, and the references of those RCTs were also searched by hand. After study selection, assessment and data extraction were conducted by two reviewers independently. Meta-analyses were performed by using the RevMan 5. software. RESULTS AND CONCLUSION: Five studies involving 36 patients were included. The results of Meta-analyses showed that: compared with the supination maneuvers group the pronation maneuvers group had a higher rate of successful reduction at the first attempt [RR=.7, 95%CI (.08,.8), P=0.000 3] and lower rate of failed reduction [RR=0.5, 95%CI (0.09, 0.65), P=0.005]. There was no significant difference in the rate of successful Feng Fan, Studying for master s degree, Fourth Department of Orthopedics, Zhongnan Hospital of Wuhan University, Wuhan 3007, Hubei Province, China Accepted: 05-06-09 50 P.O. Box 000, Shenyang 080
. Meta reduction at the second attempt [RR=.39, 95%CI (0.75,.58), P=0.30]. Based on the results of systemic assessment, the level of evidence assessed by the GRADE system showed that the outcome indicators of the rate of successful reduction at the first attempt and rate of failed reduction were graded as intermediate level; the outcome indicator of the rate of successful reduction at the second attempt was graded as low level. For the poor quality of the original studies, a prudent choice is suggested; and more highly-quality, large-sample studies are needed. Subject headings: Radius; Dislocations; Pronation; Supination Feng F, Deng ZM, Ran B, Xie YL, Ruan WF, Cai L. Pronation versus supination maneuvers for the reduction of radial head subluxation: A Meta-analysis. Zhongguo Zuzhi Gongcheng Yanjiu. 05;9(33):50-507. 0 Introduction (radial head subluxation RHS) [-] < 5 [3] 3 [-5] [6] [7] [5-6] [8-0] GRADE Data and methods. / (RCT) the Cochrane Central Register of Controlled Trials(CENTRAL) PubMed EMbase theisi Web of Knowledge Database CNKI CMB VIP05 3 PubMed # radial head subluxation OR RHS OR pulled elbow # pronationreduction OR hyperpronation reduction #3 supination reduction OR supination-flexion reduction # # and # and #3 CNKI # OR RHS OR # #3 # # and # and #3..... 7..3....5.3.3. Cochrane 5. [] RCT3 Low risk High riskunclear risk.3. GRADE [] ( A) ( B) ( C) ISSN 095-3 CN -58/R CODEN: ZLKHAH 503
. Meta ( D) RCT 5 3. 3 RCT.5 MetaCochrane Rev-Man 5.3 I P 0. I 50% P < 0. I > 50% (Meta ) Meta (RR) (MD) (SMD) 95% (CI) GRADEpro 3.6 [3] 3 Results. RCT 95 55337 5 3 5 [-8] 36 Meta Table General information of included studies about pronation versus supination maneuvers for the reduction of radial head subluxation in children ( / n) ( ) Bek 009 3 3/ 3/9 Green 006 35 37 Guzel 0 0 9/ 38 9/9 Macias 998 5/6 9/5. Cochrane 5 ( 3) 5 McDonald [8] 3Green [5].3 Meta 5 (P=0.37 I =7%) 60 6 8 6 8 7 McDonald 999 67 30/37 5 7 68 8/0 3 60 (n=95) (n=5) (n=3) (n=5) (n=5) (n=0) (Meta )(n=5) (n=8) (n=9) Meta Figure Meta-analysis screening of literature about pronation versus supination maneuvers for the reduction of radial head subluxation in children 50 P.O. Box 000, Shenyang 080
. Meta Meta Figure Bias risk map of Meta-analysis of pronation versus supination maneuvers for the reduction of radial head subluxation in children 3 Meta Figure 3 Bias risk map of Meta-analysis of pronation versus supination maneuvers for the reduction of radial head subluxation in children Meta GRADE Table GRADE conclusive table of the Meta-analysis of pronation versus supination maneuvers for the reduction of radial head subluxation in children GRADE [n/n(%)] [n/n(%)] 5 RCT 93/7(88.9) 63/9(7.) RR=.7 95%CI (.08.8) RCT 5/0(75.0) /(50.0) RR=.39 95%CI (0.75.58) 5 RCT /7(.8) /9(9.6) RR=0.5 95%CI (0.09 0.65) ( ) [RR=.7 95%CI(.08.8) P=0.000 3] 5 5 (P=0.03 I =67%) [RR=.39 95%CI(0.75.58) P=0.30] 56 (P=0.88 I =0%) ( ) [RR=0.5 95%CI(0.09 0.65) P=0.005]. GRADE 3 GRADE 3 Discussion 3. 3 3. Meta 3.3 ISSN 095-3 CN -58/R CODEN: ZLKHAH 505
. Meta Study or Subgroup Bek, D. 009 Green, D. A. 006 Guzel, M. 0 Macias, C. G.998 McDonald, J. 999 Risk Ratio Risk Ratio 36 0 53 3 35 0 67 3 5 38 7 37 38 68 Weight.3%.0%.% 38.7% 6.9%.37 [.07,.75].09 [0.9,.30].37 [.06,.76].3 [0.99,.8]. [0.9,.0] (95% CI) 7 9 00.0% events 93 63 Heterogeneity: Tau² = 0.00; Chi² =.30, df = (P = 0.37); I² = 7% Test for overall effect: Z = 3.66 (P = 0.0003).7 [.08,.8] 0.5 0.7.5 Meta Figure Meta-analysis of the rate of successful reduction at the first attempt in pronation and supination maneuvers groups Study or Subgroup Bek, D. 009 Guzel, M. 0 Macias, C. G.998 McDonald, J. 999 Risk Ratio Risk Ratio Weight 3 9 3 7 7 0 7 6 7.% 33.3% 9.7% 9.8%. [0.6,.3].00 [0.66,.5].7 [0., 3.08] 3.38 [.9, 8.85] (95% CI) events 5 Heterogeneity: Tau² = 0.5; Chi² = 9.0, df = 3 (P = 0.03); I² = 67% Test for overall effect: Z =.05 (P = 0.30) 0 00.0%.39 [0.75,.56] 0.0 0. 0 00 5 Meta Figure 5 Meta-analysis of the rate of successful reduction at the second attempt in pronation and supination maneuvers groups Study or Subgroup Bek, D. 009 Green, D. A. 006 Guzel, M. 0 Macias, C. G.998 McDonald, J. 999 Risk Ratio Risk Ratio 0 0 3 35 0 67 3 6 6 37 38 68 Weight.% 0.5%.%.0% 3.% 0.3 [0.0,.5] 0. [0.0,.5] 0.6 [0.0,.5] 0.8 [0.0,.] 0.5 [0.0,.68] (95% CI) 7 9 00.0% events Heterogeneity: Tau² = 0.00; Chi² =.9, df = (P = 0.88); I² = 0% Test for overall effect: Z =.83 (P = 0.005) 0.5 [0.09, 0.65] 0.05 0. 5 0 6 Meta Figure 6 Meta-analysis of the rate of failed reduction in pronation and supination maneuvers groups 506 3. GRADE GRADE RCT P.O. Box 000, Shenyang 080
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