摘要
目的:系统评价不同手术方法治疗桡骨远端骨折的临床疗效和安全性。方法:应用计算机检索中国知网、维普网、万方数据库、中国生物医学文献服务系统、PubMed、Embase、Cochrane Library、Web of Science中关于手术方法治疗桡骨远端骨折的随机对照试验,检索时限均为建库至2024年6月1日。试验组和对照组均采用手术方法治疗。依据文献检索及筛选方案筛选出符合要求的文献后,由2名研究人员分别独立进行数据提取和质量评价。采用Stata15.0软件绘制网状关系图,对疗效优良率、并发症发生情况及腕关节桡偏、尺偏、掌屈、背伸、旋前、旋后活动度进行网状Meta分析,并根据累计概率排名曲线下面积(the surface under the cumulative ranking curve,SUCRA)对手术方法的疗效进行排序。采用比较-校正漏斗图进行发表偏倚检验。结果:共检索到10320篇文献,通过逐层筛选最终纳入34篇文献,涉及切开复位钢板内固定、闭合复位支架外固定、闭合复位克氏针内固定、闭合复位髓内钉内固定、腕关节镜技术联合切开复位钢板内固定、切开复位钢板内固定联合局部植骨6种手术方法。网状Meta分析结果显示,在疗效优良率方面,不同手术方法治疗桡骨远端骨折的疗效排序为腕关节镜技术联合切开复位钢板内固定(SUCRA=99.90%)>切开复位钢板内固定(SUCRA=49.80%)>闭合复位支架外固定(SUCRA=41.50%)>闭合复位克氏针内固定(SUCRA=8.80%);在腕关节桡偏活动度方面,不同手术方法治疗桡骨远端骨折的疗效排序为腕关节镜技术联合切开复位钢板内固定(SUCRA=85.10%)>闭合复位克氏针内固定(SUCRA=84.70%)>闭合复位髓内钉内固定(SUCRA=41.90%)>切开复位钢板内固定(SUCRA=36.20%)>闭合复位支架外固定(SUCRA=2.00%);在腕关节尺偏活动度方面,不同手术方法治疗桡骨远端骨折的疗效排序为切开复位钢板内固定(SUCRA=86.90%)>闭合复位髓内钉内固定(SUCRA=67.90%)>闭合复位克氏针内固定(SUCRA=43.50%)>闭合复位支架外固定(SUCRA=36.90%)>腕关节镜技术联合切开复位钢板内固定(SUCRA=14.70%);在腕关节掌屈活动度方面,不同手术方法治疗桡骨远端骨折的疗效排序为腕关节镜技术联合切开复位钢板内固定(SUCRA=87.10%)>闭合复位髓内钉内固定(SUCRA=65.90%)>闭合复位克氏针内固定(SUCRA=62.30%)>切开复位钢板内固定(SUCRA=34.00%)>闭合复位支架外固定(SUCRA=0.70%);在腕关节背伸活动度方面,不同手术方法治疗桡骨远端骨折的疗效排序为切开复位钢板内固定(SUCRA=90.80%)>闭合复位髓内钉内固定(SUCRA=69.40%)>闭合复位克氏针内固定(SUCRA=33.90%)>闭合复位支架外固定(SUCRA=32.90%)>腕关节镜技术联合切开复位钢板内固定(SUCRA=23.10%);在腕关节旋前活动度方面,不同手术方法治疗桡骨远端骨折的疗效排序为切开复位钢板内固定(SUCRA=93.50%)>闭合复位髓内钉内固定(SUCRA=59.00%)>闭合复位支架外固定(SUCRA=41.30%)>闭合复位克氏针内固定(SUCRA=32.50%)>腕关节镜技术联合切开复位钢板内固定(SUCRA=23.80%);在腕关节旋后活动度方面,不同手术方法治疗桡骨远端骨折的疗效排序为切开复位钢板内固定(SUCRA=89.80%)>闭合复位支架外固定(SUCRA=55.80%)>闭合复位髓内钉内固定(SUCRA=54.80%)>闭合复位克氏针内固定(SUCRA=27.60%)>腕关节镜技术联合切开复位钢板内固定(SUCRA=22.00%);在并发症发生情况方面,不同手术方法治疗桡骨远端骨折的安全性排序为切开复位钢板内固定联合局部植骨(SUCRA=85.70%)>腕关节镜技术联合切开复位钢板内固定(SUCRA=71.40%)>闭合复位髓内钉内固定(SUCRA=58.30%)>闭合复位克氏针内固定(SUCRA=47.30%)>切开复位钢板内固定(SUCRA=25.00%)>闭合复位支架外固定(SUCRA=12.30%)。结论:现有的证据表明,采用切开复位钢板内固定是治疗桡骨远端骨折的优选手术方法,能够改善腕关节活动度,获得良好的临床疗效,而切开复位钢板内固定联合腕关节镜技术、局部植骨等手术方法在一定程度上能够减少切开复位钢板内固定的并发症。
Objective:To systematically review the clinical outcomes and safety of different surgical procedures in treatment of distal radius fractures(DRFs).Methods:All the randomized controlled trial(RCT)articles about surgical procedures for treatment of DRFs included from database’s inception to June 1,2024 were retrieved from the China National Knowledge Infrastructure,Vip Database,Wanfang Database,Chinese Biomedical Literature Service System,PubMed,Embase,Cochrane Library,and Web of Science through computer.The patients in experiment group and control group were all treated with surgical procedures.The eligible articles were screened according to the retrieval and screening scheme.The information was extracted and the methodological quality of the included researches in the articles was evaluated independently by two researchers.After that,the reticulated plots were drawn by using Stata15.0 software,and a reticulated Meta-analysis on excellent and good rate of efficacy,complication incidence rate,as well as wrist range of motions(ROMs)including radial devi-ation,ulnar deviation,palmar flexion,dorsal expansion,pronation and supination was conducted,furthermore,the efficacies of the adopted surgical methods were ranked according to the surface under the cumulative ranking curve(SUCRA),and the publication bias was tested by using a comparison-correction funnel plot.Results:Ten thousand three hundred and twenty articles were searched out.After screening,34 articles were included in the final analysis,involving open reduction(OR)and plate internal fixation,closed reduction(CR)and frame external fixation,CR and Kirschner wire(K-wire)internal fixation,CR and intramedullary nail(IMN)internal fixation,wrist arthroscopic technique(WAT)combined with OR and plate internal fixation,as well as OR and plate internal fixation combined with local bone grafting(LBG).The results of reticulated Meta-analysis revealed that,in treatment of DRFs,the WAT combined with OR and plate internal fixation(SUCRA=99.90%)behaved best in the excellent and good rate of efficacy,followed by OR and plate internal fixation(SUCRA=49.80%),CR and frame external fixation(SUCRA=41.50%),and CR and K-wire internal fixation(SUCRA=8.80%);the WAT combined with OR and plate internal fixation(SUCRA=85.10%)behaved best in wrist ROM of radial deviation,followed by CR and K-wire internal fixation(SUCRA=84.70%),CR and IMN internal fixation(SUCRA=41.90%),OR and plate internal fixation(SUCRA=36.20%),and CR and frame external fixation(SUCRA=2.00%);the OR and plate internal fixation(SUCRA=86.90%)behaved best in wrist ROM of ulnar deviation,followed by CR and IMN internal fixation(SUCRA=67.90%),CR and K-wire internal fixation(SUCRA=43.50%),CR and frame external fixation(SUCRA=36.90%),and WAT combined with OR and plate internal fixation(SUCRA=14.70%);the WAT combined with OR and plate internal fixation(SUCRA=87.10%)behaved best in wrist ROM of palmar flexion,followed by CR and IMN internal fixation(SUCRA=65.90%),CR and K-wire internal fixation(SUCRA=62.30%),OR and plate internal fixation(SUCRA=34.00%),and CR and frame external fixation(SUCRA=0.70%);the OR and plate internal fixation(SUCRA=90.80%)behaved best in wrist ROM of dorsal expansion,followed by CR and IMN internal fixation(SUCRA=69.40%),CR and K-wire internal fixation(SUCRA=33.90%),CR and frame external fixation(SUCRA=32.90%),and WAT combined with OR and plate internal fixation(SUCRA=23.10%);the OR and plate internal fixation(SUCRA=93.50%)behaved best in wrist ROM of pronation,followed by CR and IMN internal fixation(SUCRA=59.00%),CR and frame external fixation(SUCRA=41.30%),CR and K-wire internal fixation(SUCRA=32.50%),and WAT combined with OR and plate internal fixation(SUCRA=23.80%);the OR and plate internal fixation(SUCRA=89.80%)behaved best in wrist ROM of supination,followed by CR and frame external fixation(SUCRA=55.80%),CR and IMN internal fixation(SUCRA=54.80%),CR and K-wire internal fixation(SUCRA=27.60%),and WAT combined with OR and plate internal fixation(SUCRA=22.00%);the OR and plate internal fixation combined with LBG(SUCRA=85.70%)behaved best in complication incidence rate,followed by WAT combined with OR and plate internal fixation(SUCRA=71.40%),CR and IMN internal fixation(SUCRA=58.30%),CR and K-wire internal fixation(SUCRA=47.30%),OR and plate internal fixation(SUCRA=25.00%),and CR and frame external fixation(SUCRA=12.30%).Conclusion:Available evidences suggest that,the OR and plate internal fixation behaves best in treating DRFs,and it can improve the wrist ROM and achieve better clinical outcomes;while,the OR and plate internal fixation combined with WAT or LBG can reduce the complications resulting from OR and plate internal fixation to some extent.
作者
吕德梁
李国梁
赵建勇
王鑫
袁野
王铁强
王旭洋
刘文东
沈润斌
LYU Deliang;LI Guoliang;ZHAO Jianyong;WANG Xin;YUAN Ye;WANG Tieqiang;WANG Xuyang;LIU Wendong;SHEN Runbin(Cangzhou Hospital of Integrated TCM-WM·Hebei,Cangzhou 061001,Hebei,China;Hebei Provincial 3D Printing Technology Innovation Center of Integrated Traditional Chinese and Western Medicine,Cangzhou 061001,Hebei,China;College of Traditional Chinese Medicine,North China University of Science and Technology,Tangshan 063210,Hebei,China)
出处
《中医正骨》
2025年第1期9-19,25,共12页
The Journal of Traditional Chinese Orthopedics and Traumatology
基金
河北省医学科学研究课题(20240655)。
