| 226 | 14 | 27 |
| 下载次数 | 被引频次 | 阅读次数 |
目的：应用Meta分析的方法比较切开复位掌侧锁定钢板内固定与闭合复位外固定治疗桡骨远端骨折的疗效差异。方法：检索中国知网、万方、维普、中国生物医学文献、Pubmed、Embase、Cochrane Library数据库，收集自建库以来至2023年4月公开发表的直接比较钢板内固定与闭合复位外固定治疗桡骨远端骨折疗效差异的随机对照研究。2名研究者根据纳入及排除标准对检索文献进行独立筛选，提取数据并采用Cochrane风险偏倚评估工具进行质量评估，并使用RevMan 5.4软件进行Meta分析。结果：共纳入10篇随机对照试验研究，均为英文文献，共计1 042例患者，其中9篇文献质量评为低风险。Meta分析结果显示，掌侧锁定钢板内固定治疗桡骨远端骨折在1年后DASH评分[MD=-5.64,95%CI（-7.21，-4.06）,P<0.000 01];1年后PRWE评分[MD=-5.90,95%CI（-8.88，-2.92）,P=0.001]；掌屈[MD=5.92,95%CI(1.29,10.55),P=0.01]；旋前[MD=2.48,95%CI(0.59,4.36),P=0.01]；旋后[MD=4.73,95%CI(2.15,7.31),P=0.0003]；握力[MD=0.61,95%CI(0.12,1.10),P=0.02]；掌倾角[MD=9.84,95%CI(5.66,14.02),P<0.000 01]；尺偏角[MD=4.33,95%CI(2.97,5.69),P<0.000 01]方面均优于闭合复位石膏或夹板外固定治疗。二者在1年后欧洲五维健康量表（EQ-5D-5L）评分[MD=0.02,95%CI（-0.01,0.05）,P=0.27]；背伸[MD=2.22,95%CI（-4.15,8.59）,P=0.49]；尺偏[MD=3.49,95%CI（-0.80,7.78）,P=0.11]；桡偏[MD=2.05,95%CI（-2.39,6.50）,P=0.37]；尺骨变异[MD=-1.14,95%CI（-3.16,0.88）,P=0.27]；并发症[MD=0.77,95%CI(0.54,1.10),P=0.16]方面差异均无统计学意义（P>0.05）。结论：基于当前临床数据，掌侧锁定钢板内固定较闭合复位石膏或夹板外固定治疗更有利于中期DASH评分和握力恢复，但患者的生活质量及并发症等无明显差异。对于成人桡骨远端骨折，应谨慎把握手术适应症，优先考虑非手术治疗。
Abstract：Objective:To compare the efficacy of open reduction and volar locking plate internal fixation with closed reduction and external fixation in the treatment of distal radius fractures by using meta analysis.Methods:The databases of CNKI,Wanfang,VIP,Chinese biomedical literature,PubMed,Embase,and Cochrane Library were retrieved,and the randomized controlled studies that directly compared the efficacy of plate internal fixation and closed reduction external fixation in the treatment of distal radius fractures published publicly from the establishment of the database to April 2023 were collected.The two researchers independently screened the retrieved literature according to the inclusion and exclusion criteria,extracted data,used Cochrane risk bias assessment tool for quality assessment,and used RevMan 5.4 software for meta analysis.Results:A total of 10 randomized controlled trials were included,all of which were in English.There were 1 042 patients in total,and 9 of them were rated as low risk.Meta analysis results showed that one year after the treatment of distal radius fracture with volar locking plate internal fixation,DASH score[MD=-5.64,95% CI(-7.21,-4.06),P<0.000 01];One year later,PRWE score [MD=-5.90,95 % CI(-8.88,-2.92),P=0.001];Palm flexion [MD=5.92,95%CI(1.29,10.55),P=0.01];Pronation [MD=2.48,95%CI(0.59,4.36),P=0.01];Postrotation[MD=4.73,95%CI(2.15,7.31),P=0.000 3];Grip strength [MD=0.61,95%CI(0.12,1.10),P=0.02];Palmar tilt angle [MD=9.84,95%CI(5.66,14.02),P<0.000 01];Radial inclination[MD=4.33,95%CI(2.97,5.69),P<0.000 01] was superior to closed reduction plaster or splint external fixation.One year later,the European Five dimensional Health Scale(EQ-5D-5L) score[MD=0.02,95% CI(-0.01,0.05),P=0.27];Back extension[MD=2.22,95%CI(-4.15,8.59),P=0.49];Ulnar deviation[MD=3.49,95%CI(-0.80,7.78),P=0.11];Radial deviation[MD=2.05,95%CI(-2.39,6.50),P=0.37];Ulnar variance[MD=-1.14,95%CI(-3.16,0.88),P=0.27];There was no significant difference in complications [MD=0.77,95%CI(0.54,1.10),P=0.16](P>0.05).Conclusion:Based on the current clinical data,internal fixation with volar locking plate is more conducive to mid-term DASH score and grip strength recovery than closed reduction plaster or splint external fixation,but there is no significant difference in the quality of life and complications of patients.For adult distal radius fractures,surgical indications should be carefully grasped,and non operative treatment should be given priority.
1李柿樾,卜建文,谢增如.桡骨远端骨折的治疗进展[J].实用手外科杂志,2022,36(1):97-101.
2 Chaudhry H,Kleinlugtenbelt YV,Mundi R,et al.Are volar locking plates superior to percutaneous k-wires for distal radius fractures a meta-analysis[J].Clin Orthop Relat Res,2015,473(9):3017-3027.
3 Arora R,Lutz M,Deml C,et al.A prospective randomized trial comparing nonoperative treatment with volar locking plate fixation for displaced and unstable distal ra-dial fractures in patients sixty-five years of age and older[J].J Bone Joint Surg Am,2011,93(23):2146-2153.
4王楠,杜国庆,蔡雨卫,等.桡骨远端骨折固定方法的研究进展[J].医学综述,2020,26(6):1131-1136.
5 Sorensen AA,Howard D,Tan WH,et al.Minimal clinically important differences of 3 patient-rated outcomes instruments[J].J Hand Surg Am,2013,38(4):641-649.
6 Moher D,Liberati A,Tetzlaff J,et al.Preferred reporting items for systematic reviews and meta-analyses:The PRISMA statement[Jl.PLoS Med,2009,6(7):e1000097.
7 Higgins JPT,Thomas J,Chandler J,et al.Cochrane handbook for systematic reviews of interventions version6.3(updated February 2022).Cochrane,2022.Available from www.training.cochrane.org/handbook.
8 Bartl C,Stengel D,Bruckner T,et al.The treatment of displaced intra-articular distal radius fractures in elderly patients[J].Dtsch Arztebl Int,2014,111(46):779-787.
9 Martinez-Mendez D,Lizaur-Utrilla A,de-Juan-Herrero J.Intra-articular distal radius fractures in elderly patients:A randomized prospective study of casting versus volar plating[J].J Hand Surg Eur Vol,2018,43(2):142-147.
10 Lawson A,Naylor JM,Buc.hbinder R,et al.Surgical plating vs closed reduction for fractures in the distal radius in older patients:A randomized clinical trial[J].JAMA Surg,2021,156(3):229-237.
11 Südow H,Severin S,Wilcke M,et al.Non-operative treatment or volar locking plate fixation for dors ally displaced distal radius fractures in patients over 70 years-a three year follow-up of a randomized controlled trial[J].BMC Musculoskelet Disord,2022,23(1):447.
12 Hassellund SS,Williksen JH,Laane MM,et al.Infographic:Cast immobilization is non-inferior to volar locking plates in relation to QuickDASH after one year in patients aged 65 years and older:A randomized controlled trial of displaced distal radius fractures[J].Bone Joint J,2021,103-B(2):245-246.
13 Sharma H,Khare GN,Singh S,et al.Outcomes and complications of fractures of distal radius(AO type B and C):Volar plating versus nonoperative treatment[J].J Orthop Sci,2014,19(4):537-544.
14 Saving J,Severin Wahlgren S,Olsson K,et al.Nonoperative treatment compared with volar locking plate fixation for dorsally displaced distal radial fractures in the elderly:A randomized controlled trial[J].J Bone Joint Surg Am,2019,101(11):961-969.
15 Mulders MAM,Walenkamp MMJ,van Dieren S,et al.Volar plate fixation versus plaster immobilization in acceptably reduced extra-articular distal radial fractures:A multicenter randomized controlled trial[J].J Bone Joint Surg An,2019,101(9):787-796.
16 Arora R,Lutz M,Deml C,et al.A prospective randomized trial comparing nonoperative treatment with volar locking plate fixation for displaced and unstable distal radial fractures in patients sixty-five years of age and older[J].J Bone Joint Surg Am,2011,93(23):2146-2153.
17 Selles CA,Mulders MAM,Winkelhagen J,et al.Volar plate fixation versus cast immobilization in acceptably reduced intra-articular distal radial fractures:A randomized controlled trial[J].J Bone Joint Surg Am,2021,103(21):1963-1969.
18 Egol KA,Walsh M,Romo-Cardoso S,et al.Distal radial fractures in the elderly:Operative compared with nonoperative treatment[J].J Bone Joint Surg Am,2010,92(9):1851-1857.
19 Hammer OL,Clementsen S,Hast J,et al.Volar locking plates versus augmented external fixation of intra-articular distal radial fractures:Functional results from a randomized controlled trial[J],J Bone Joint Surg Am,2019,101(4):311-321.
20 Keast-Butler O,Schemitsch EH.Biology versus mechanics in the treatment of distal radial fractures[J].J Orthop Trauma,2008,22(8 Stppl):S91-95.
21 MacFarlane RJ,Miller D,Wilson L,et al.Functional outcome and complications at 2.5 years following volar locking plate fixation of distal radius fractures[J].J Hand Microsurg,2015,7(1):18-24.
22 Delclaux S,Trang Pham TT,Bonnevialle N,et al.Distal radius fracture malunion:Importance of managing injuries of the distal radio-ulnar joint[J].Orthop Traumatol Surg Res,2016,102(3):327-332.
23 Handoll HH,Huntley JS,Madhok R.External fixation versus conservative treatment for distal radial fractures in adults[J].Cochrane Database Syst Rev,2007,18;(3):CD006194.
24彭斌,王健,毛峰.手术与石膏外固定治疗桡骨远端不稳定骨折疗效比较[J].中国骨伤,2013,26(1):41-46.
25 Ju JH,Jin GZ,Li GX,et al.Comparison of treatment outcomes between nonsurgical and surgical treatment of distal radius fracture in elderly:A systematic review and meta-analysis[J].Langenbecks Arch Surg,2015,400(7):767-779.
26 Chen Y,Chen X,Li Z,et al.Safety and efficacy of operative versus nonsurgical management of distal radiusfractures in elderly patients:A systematic review and meta-analysis[J].J Hand Surg Am,2016,41(3):404-413.
27 Abramo A,Kopylov P,Tagil M,Evaluation of a treatment protocol in distal radius fractures:A prospective study in 581 patients using DASH as outcome[J].Acta Orthop,2008,79(3):376-385.
28 Landgren M,Abramo A,Geijor M,et al.Similar1-year subjective outcome after a distal radius fracture during the 10-year-period 2003-2012[J].Acta Orthop,2017,88(4):451-456.
29 Ochen Y,Peek J,van der Velde D,et al.Operative vs nonoperative treatment of distal radius fractures in adults:A systematic review and meta-analysis[J].JAMA Netw Open,2020,3(4):e203497.
30 He B,Tian X,Ji G,et al.Comparison of outcomes between nonsurgical and surgical treatment of distal radius fracture:A systematic review update and meta-analysis[J].Arch Orthop Trauma Surg,2020,140(8):1143-1153.
31 Finsen V,Rod O,R?d K,et al.The relationship between displacement and clinical outcome after distal radius(Colles')fracture[J].J Hand Surg Eur Vol,2013,38(2):116-126.
32 Bentohami A,Bijlsma TS,Goslings JC,et al.Radiological criteria for acceptable reduction of extra-articular distal radial fractures are not predictive forpatient-reported functional outcome[J].J Hand Surg Eur Vol,2013,38(5):524-529.
33 Synn AJ,Makhni EC,Makhni MC,et al.Distal radius fractures in older patients:Is anatomic reduction necessary[J].Clin Orthop Relat Res,2009,467(6):1612-1620.
34 Song J,Yu AX,Li ZH.Comparison of conservative and operative treatment for distal radius fracture:A meta-analysis of randomized controlled trials[J].Int J Clin Exp Med,2015,8(10):17023-17035.
35 Yu GS,Lin YB,Le LS,et al.Internal fixation vs conservative treatment for displaced distal radius fractures:A meta-analysis of randomized controlled trials[J].Ulus Travma Acil Cerrahi Derg,2016(22(3):233-241.
36 Corsino C.B,Reeves RA,Sieg RN.Distal radius fractures.2022 May 1.In:StatPearls[Internet].Treasure Island(FL):StatPearls Publishing;2022 Jan.
37 Ferree S,Van der Vliet QMJ,Nawijn F,et al.Epidemiology of distal radius fractures in polytrauma patients and the influence of high traumatic energy transfer[J].Injury,2018,49(3):630-635.
38 Van der Vliet QMJ,Sweet AAR,Bhashyam AR,et al.Polytrauma and high-energy injury mechanisms are associated with worse patient-reported outcomes after distal radius fractures[J].Clin Orthop Relat Res,2019,477(10):2267-2275.
基本信息:
DOI：10.13210/j.cnki.jhmu.20230425.001
中图分类号:R687.3
引用信息:
[1]陈牮阁,张海宁,赵洪洲,等.掌侧钢板内固定与闭合复位外固定治疗成人桡骨远端骨折疗效的Meta分析[J].海南医学院学报,2023,29(19):1491-1504.DOI:10.13210/j.cnki.jhmu.20230425.001.
基金信息:
2022年中医药重点专科建设项目：中医骨伤科（962042）; 2020年区域中医（骨伤科）诊疗中心（津卫中[2020]5号）~~
2023-04-25
2023-04-25
2023-04-25