| 钢板与外固定架固定治疗AO-C型桡骨远端骨折疗效的Meta分析 |
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投稿时间：2024-08-13
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| 作者 | Author | 单位 | Address | E-Mail |
| 李光耀 |
LI Guang-yao |
北京中医药大学, 北京 100029 |
Beijing University of Chinese Medicine, Beijing 100029, China |
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| 成永忠 |
CHENG Yong-zhong |
中国中医科学院望京医院创伤一科, 北京 100102
南阳市中医院, 河南 南阳 473007 |
Department of Traumatology, Wangjing Hospital, China Academy of Chinese Medical Sciences, Beijing 100102, China
Nanyang Hospital of Traditional Chinese Medicine, Nanyang 473007, Henan, China |
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| 刘峘 |
LIU Huan |
中国中医科学院中医临床基础医学研究所, 北京 100700 |
Institute of Basic Research in Clinical Medicine, China Academy of Chinese Medical Sciences, Beijing 100700, China |
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| 姜俊杰 |
JIANG Jun-jie |
中国中医科学院中医临床基础医学研究所, 北京 100700 |
Institute of Basic Research in Clinical Medicine, China Academy of Chinese Medical Sciences, Beijing 100700, China |
18910206360@163.com |
| 李永耀 |
LI Yong-yao |
中国中医科学院望京医院创伤一科, 北京 100102 |
Department of Traumatology, Wangjing Hospital, China Academy of Chinese Medical Sciences, Beijing 100102, China |
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| 陈洋 |
CHEN Yang |
中国中医科学院望京医院创伤一科, 北京 100102 |
Department of Traumatology, Wangjing Hospital, China Academy of Chinese Medical Sciences, Beijing 100102, China |
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| 姚宇翔 |
YAO Yu-xiang |
中国人民解放军 66322部队, 北京 100000 |
Unit 66322 of the People's Liberation Army, Beijing 100000, China |
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| 期刊信息：《中国骨伤》2025年，第38卷，第1期，第66-80页 |
| DOI：10.12200/j.issn.1003-0034.20240557 |
| 基金项目:北京市科学技术委员会-首都临床特色诊疗技术研究及转化应用(编号:Z221100007422075);中国中医科学院科技创新工程-重大攻关项目(编号:CI2021A02008) |
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中文摘要:
目的: Meta分析钢板与外固定架固定治疗AO-C型桡骨远端骨折的临床疗效。
方法: 检索PubMed、Embase、Cochrane Library、Web of Science、中国知网、万方、维普和SinoMed数据库所有关于AO-C型桡骨远端骨折的随机对照临床试验的文献，检索时限均从各数据库建库到2023年6月30日。纳入研究参照Cochrane手册(Version 6.3，2022)进行信息提取、文献质量评价，采用RevMan 5.4软件进行发表偏倚风险评价、检验异质性并进行Meta分析。结局指标为:影像学解剖指标(掌倾角、尺偏角、桡骨高度)、腕关节活动度(屈伸、旋转、尺桡偏)、并发症发生率、手术治疗情况比较(手术出血量、手术时间、住院时间、骨折愈合时间)和腕关节功能评分及相关量表。
结果: (1)共纳入28项研究，患者共计2 192例，包括1 096例钢板内固定组和1 096例外固定架组。(2)Meta分析结果显示:外固定架组的手术出血量[MD=-37.93，95%CI(-48.54，-27.31)，P<0.000 01]、手术时间[MD=-31.58，95%CI(-48.96，-14.20)，P=0.000 4]、住院时间[MD=-4.58，95%CI(-5.44，-3.71)，P<0.000 01]、骨折愈合时间[MD=-0.88，95%CI(-1.35，-0.41)，P=0.000 2]均显著优于钢板内固定组(P<0.05)。(3)两组的掌倾角[MD=-0.17，95%CI(-0.95，0.61)，P=0.68]、尺偏角[MD=0.22，95%CI(-0.73，1.17)，P=0.65]、桡骨高度[MD=-0.24，95%CI(-1.15，0.67)，P=0.60]，屈伸[MD=-5.63，95%CI(-11.85，0.58)，P=0.08]、旋转[MD=-5.80，95%CI(-12.77，1.17)，P=0.10]、尺桡偏[MD=-2.86，95%CI(-10.87，5.15)，P=0.48]，并发症发生率[RR=0.96，95%CI(0.63，1.46)，P=0.83]，Gartland-Werley腕部临床评分[MD=0.13，95%CI(-0.80，1.06)，P=0.78]、Gartland-Werley腕部临床评分优良率[RR=0.93，95%CI(0.87，1.01)，P=0.08]、Cooney腕关节评分优良率[RR=0.99，95%CI(0.62，1.59)，P=0.98]、腕关节DASH评分[MD=-4.67，95%CI(-14.96，5.62)，P=0.37]的差异均无统计学意义(P>0.05)。
结论: 与钢板内固定相比，外固定架治疗AO-C型桡骨远端骨折可以显著减少手术出血量、缩短手术时间与住院时间和骨折愈合时间，其影像学解剖指标、腕关节活动度、并发症发生率和腕关节功能评分两者相当。 |
| 【关键词】钢板内固定 外固定架 AO-C型桡骨远端骨折 Meta分析 |
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| Meta-analysis of the efficacy of plate fixation and external fixator fixation in the treatment of AO-C type distal radius fractures |
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ABSTRACT
Objective Meta-analysis of the clinical efficacy of plate and external fixator fixation in the treatment of AO-C type distal radius fractures.
Methods PubMed,Embase,Cochrane Medical Library,Web of Science,CNKI,Wanfang,VIP and SinoMed databases were searched for all literature on randomized controlled clinical trials of AO-C distal radius fractures. The search time limits were from each database. The database will be established until June 30,2023. The included studies were extracted according to the Cochrane Handbook (Version 6.3,2022) for information extraction and literature quality evaluation. RevMan 5.4 was used to evaluate the risk of Publication bias,test heterogeneity and Perform Meta-analysis. The outcome indicators were:imaging anatomy indicators (volar inclination angle,ulnar deviation angle,radial height),wrist joint mobility (flexion,extension,rotation,ulnar deviation),complication rate,and comparison of surgical treatments (operative blood loss,operation time,hospitalization time,fracture healing time) and wrist joint function scores and related scales.
Results (1) A total of 28 studies were included,with a total of 2 192 patients,including 1 096 cases in the plate internal fixation group and 1 096 cases in the external fixation group.(2) Meta analysis results showed:the surgical treatment situation of the external fixation group:surgical blood loss MD=-37.93,95%CI(-48.54,-27.31),P<0.000 01;operation time MD=-31.58,95%CI(-48.96,-14.20),P<0.000 4;hospitalization time MD=-4.58,95%CI(-5.44,-3.71),P<0.000 01;the fracture healing time MD=-0.88,95%CI(-1.35,-0.41),P<0.000 2,which were significantly better than that of the plate internal fixation group(P<0.05).(3) The two groups:palmar inclination angle MD=-0.17,95%CI(-0.95,0.61),P=0.68;ulnar declination MD=0.22,95%CI(-0.73,1.17),P=0.65,radial height MD=-0.24,95%CI(-1.15,0.67),P=0.60;flexion and extension MD=-5.63, 95%CI(-11.85,0.58),P=0.08;rotation MD=-5.80,95%CI(-12.77,1.17),P=0.10,radioulnar deviation MD=-2.86,95%CI(-10.87,5.15),P=0.48;complication rate RR=0.96,95%CI(0.63,1.46),P=0.83;Gartland-Werley clinical wrist score MD=0.13,95%CI(-0.80,1.06),P=0.78;excellent and good rate of Gartland-Werley wrist clinical score RR=0.93,95%CI(0.87,1.01),P=0.08;excellent and good rate of Cooney wrist score RR=0.99,95%CI(0.62,1.59),P=0.98;wrist DASH score MD=-4.67,95%CI(-14.96,5.62),P=0.37;the differences were not significant (P>0.05).
Conclusion Compared with internal fixation with plate,external fixation can significantly reduce the amount of surgical bleeding,shorten the operation time,hospitalization time and fracture healing time,and its imaging anatomical indicators,wrist mobility,and complications can be significantly reduced in treating AO-C distal radius fractures. Rates and wrist function scores were equivalent. |
| KEY WORDS Plate internal fixation External fixator AO-C type distal radius fracture Meta-analysis |
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| 引用本文，请按以下格式著录参考文献： |
| 中文格式: | 李光耀,成永忠,刘峘,姜俊杰,李永耀,陈洋,姚宇翔.钢板与外固定架固定治疗AO-C型桡骨远端骨折疗效的Meta分析[J].中国骨伤,2025,38(1):66~80 |
| 英文格式: | LI Guang-yao,CHENG Yong-zhong,LIU Huan,JIANG Jun-jie,LI Yong-yao,CHEN Yang,YAO Yu-xiang.Meta-analysis of the efficacy of plate fixation and external fixator fixation in the treatment of AO-C type distal radius fractures[J].zhongguo gu shang / China J Orthop Trauma ,2025,38(1):66~80 |
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