摘要
目的:对手法复位小夹板外固定与切开复位钢板内固定治疗桡骨远端骨折疗效的进行系统评价和Meta分析,为桡骨远端骨折临床治疗方案选择提供依据。方法:通过计算机检索万方、中国知网(CNKI)、维普和中国生物医学文献数据库(CBM),检索时间为自建库以来至2019年1月30日,检索手法复位小夹板外固定与切开复位钢板内固定治疗桡骨远端骨折疗效比较随机对照试验(randomized controlled trial,RCT),经文献质量评价后,运用Review Manager(RevMan,version 5.3)软件进行Meta分析。结果:本研究共纳入21篇文献,共1 824例患者,其中,手法复位小夹板外固定患者929例,切开复位钢板内固定患者895例,观察指标有影像学检查、Dienst腕关节功能优良率、Gartland and Werley评分优良率、骨折临床愈合时间、并发症发生率等。Meta分析结果显示:①影像学指标:钢板组在掌倾角[OR=-2.44,95%CI(-3.85,-1.02),Z=3.37,P=0.0007]、尺偏角[OR=-2.39,95%CI(-4.77,-0.47),Z=2.39,P=0.02]优于小夹板组;桡骨短缩两者无明显差异[OR=-0.52,95%CI(-1.06,0.03),Z=1.86,P=0.06];②骨折临床愈合时间比较,两者无统计学差异[OR=-1.78,95%CI(-5.75,-2.18),Z=0.88,P=0.38];③Dienst功能评分优良率[OR=0.54,95%CI(0.28,1.03),Z=1.87,P=0.06]、Gartland and Werley功能评分优良率[OR=0.95,95%CI(0.55,1.64),Z=0.18,P=0.86]、Cooney腕关节评分[OR=-0.36,95%CI(-9.28,8.56),Z=0.08,P=0.94]比较,无统计学差异;④不良反应事件比较,无统计学差异[OR=1.53,95%CI(0.56,4.16),Z=0.83,P=0.40]。结论:切开复位钢板内固定复位程度优于手法复位小夹板外固定,但在骨折临床愈合、腕关节功能和不良反应方面比较,没有统计学差异。但由于纳入研究的质量普遍不高,且观察指标欠统一和标准化,故尚需更多高质量的随机对照试验来进一步证实。
Objective:To carry out systematic evaluation and Meta analysis of the curative effect of manual reduction for small splint fixation and open reduction for plate internal fixation in the treatment of distal radius fracture in order to provide the basis for clinical treatment of distal radius fracture.Methods:Through computer searches,Wanfang,China CNKI,VIP and China biomedical literature database(CBM) were retrieved from the database to January 30,2019.Randomized controlled trial(RCT) was retrieved for the treatment of distal radius fractures with manual reduction for small splint fixation and open reduction for plate internal fixation.After evaluating the quality of literature,Meta-analysis was carried out by using Review Manager(RevMan,version 5.3).Results:A total of 21 literatures were included in this study,involving 1,824 patients,including 929 cases with manual reduction for small splint fixation and 895 cases with open reduction for plate internal fixation.The observed indexes included imaging examination,excellent and good rate of Dienst wrist joint function,excellent and good rate of Gartland and Werley score,healing time of fracture,incidence of complications,etc.Meta analysis results showed that:①Imaging indicators:The palmar inclination {OR=-2.44,95% CI [-3.85,-1.02],Z=3.37,P=0.0007},ulnar deviation {OR=-2.39,95% CI [-4.77,-0.47],Z=2.39,P=0.02} of the steel plate group were better than those of the small splint group;there was no significant difference in radius shortening between the two groups {OR=-0.52,95% CI [-1.06,0.03],Z=1.86,P=0.06}.②There was no statistical difference in the fracture healing time between the two groups {OR=-1.78,95% CI [-5.75,-2.18],Z=0.88,P=0.38}.③The excellent and good rate of Dienst functional score was {OR=0.54,95% CI [0.28,1.03],Z=1.87,P=0.06};Gartland and Werley functional score was {OR=0.95,95% CI [0.55,1.64],Z=0.18,P=0.86},Cooney wrist joint score {OR=-0.36,95% CI [-9.28,8.56],Z=0.08,P=0.94},and there had no statistical difference between them.(4) There was no significant difference in adverse events {OR=1.53,95% CI [0.56,4.16],Z=0.83,P=0.40}.Conclusion:Open reduction for plate internal fixation is better than manual reduction for small splint fixation,but there is no statistical difference in clinical healing,wrist joint function and adverse reactions.However,because the quality of the included studies is generally not high,and the observation indicators are not uniform and standardized,more high-quality randomized controlled trials are needed to further confirm.
作者
吴海洋
吴军豪
桂璟
WU Hai-yang;WU Jun-hao;GUI Jing(Shanghai Ninth People's Hospital Huangpu Branch,Shanghai,China,200011)
出处
《河南中医》
2019年第12期1890-1897,共8页
Henan Traditional Chinese Medicine
基金
上海市黄浦区科委项目(HKW201608)
关键词
桡骨远端骨折
钢板内固定
手法复位
小夹板外固定
系统评价
META分析
distal radius fractures
plate internal fixation
manual reduction
small splint fixation
systematic evaluation
Meta analysis
