| 外固定架与切开复位内固定治疗桡骨远端骨折Meta分析 |
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Received:March 05, 2020
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| 作者 | Author | 单位 | Unit | E-Mail |
| 袁术鹏 |
YUAN Shu-peng |
中国中医科学院望京医院, 北京 100102 |
Wangjing Hospital of China Academy of Chinese Medical Science, Beijing 100102, China |
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| 张兴平 |
ZHANG Xing-ping |
中国中医科学院望京医院, 北京 100102 |
Wangjing Hospital of China Academy of Chinese Medical Science, Beijing 100102, China |
xkb-office@126.com |
| 孙研 |
SUN Yan |
中国中医科学院望京医院, 北京 100102 |
Wangjing Hospital of China Academy of Chinese Medical Science, Beijing 100102, China |
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| 魏戌 |
WEI Xu |
中国中医科学院望京医院, 北京 100102 |
Wangjing Hospital of China Academy of Chinese Medical Science, Beijing 100102, China |
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| 期刊信息：《中国骨伤》2021年34卷，第5期，第429-437页 |
| DOI：10.12200/j.issn.1003-0034.2021.05.007 |
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目的： 通过Meta分析评价钢板内固定（open reduction and internal fixation，ORIF）与外固定架（external fixator，EF）固定治疗桡骨远端骨折的临床疗效及安全性。
方法： 通过计算机检索数据库，包括中国知网（CNKI）、维普（VIP）、万方数据（Wanfang Data）、Medline、Cochrane Library databases，收集ORIF与EF治疗桡骨远端骨折的随机对照试验研究。所有数据库检索年限从建库到2019年8月。根据纳排标准，对纳入研究进行数据提取及质量评价，采用RevMan 5.3软件进行Meta分析。比较2种治疗方法术后掌倾角，尺偏角，桡骨高度，握力，尺骨变异，肩臂手功能障碍（disabilities of arm，shoulder and hand，DASH）评分，总并发症发生率，感染率，肌腱断裂等结局指标。
结果： 共纳入19篇文献，1 730例患者，ORIF组873例，EF组857例。Meta分析结果显示：术后12个月两组桡骨高度[MD=0.04，95% CI （-0.90，0.99），P=0.93]，肌腱断裂[RR=1.82，95% CI （0.71，4.67），P=0.21]，腕管综合征[RR=2.15，95% CI （0.98，4.70），P=0.06]，局部复杂疼痛综合征[RR=0.63，95% CI （0.31，1.27），P=0.78]比较差异无统计学意义。而两组在掌倾角[MD=1.38，95% CI （0.83，1.93），P<0.000 01]，尺偏角[MD=0.99，95% CI （0.54，1.45），P<0.000 1]，尺骨变异[MD=0.66，95% CI （0.21，1.12），P=0.005]，DASH评分[MD=2.42，95% CI （0.37，4.46），P=0.02]，总并发症发生率[RR=0.83，95% CI （0.71，0.96），P=0.01]，感染率[RR=0.20，95% CI （0.11，0.36），P<0.000 1]方面比较差异有统计学意义。EF组肌腱炎发病率低于ORIF组[MD=3.88，95% CI （1.56，9.64），P<0.003]。
结论： ORIF在术后并发症、掌倾角、尺偏角、DASH评分、尺骨变异率、感染率方面较EF有优势。而在桡骨高度、肌腱断裂、腕管综合征及局部复杂疼痛综合征方面比较，两组无明显差异。在肌腱炎发病率方面，EF优于ORIF治疗。对于追求功能迅速恢复的患者，应考虑ORIF治疗。 |
| [关键词]:桡骨骨折 骨折固定术,内 外固定器 Meta 分析 |
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| Meta-analysis of external fixator and open reduction and internal fixation for the treatment of distal radius fracture |
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Abstract:
Objective: To compare clinical efficacy and safety of plate internal fixation (ORIF) and external fixator (EF) in treating distal radius fractures by Meta-analysis.
Methods: From establishment of database to August, 2019, randomized controlled trial (RCT) about open reduction and internal fixation (ORIF) and external fixation (EF) in treating distal radius fractures was conducted by using computer-based databases, including CNKI, VIP, Wanfang Data, Medline, Cochrane library databases. Data extraction and quality evaluation of included study according to inclusion and exclusion criteria, RevMan 5.3 software was used to perform Meta-analysis. Palm angle, ulnar deflection angle, radius height, grip strength, ulnar variation, disabilities of arm, shoulder and hand(DASH) score, total complication rate, infection rate and tendon rupture between two groups were compared.
Results: Totally 19 RCT were included with 1 730 patients, 873 patients in ORIF group and 857 patients in EF group. Meta-analysis result showed that after operation at 12 months, there were no significant difference in radial height[MD=0.04, 95%CI(-0.90, 0.99), P=0.93], tendon rupture[RR=1.82, 95%CI(0.71, 4.67), P=0.21], carpal tunnel syndrome[RR=2.15, 95%CI(0.98, 4.70), P=0.06], complex regional pain syndrom[RR=0.63, 95%CI(0.31, 1.27)P=0.78] between two groups. While there were significant difference in palm inclination angle[MD=1.38, 95%CI(0.83, 1.93), P<0.000 01], ulnar deflection angle[MD=0.99, 95%CI(0.54, 1.45), P<0.000 1], ulna variability[MD=0.66, 95%CI(0.21, 1.12), P=0.005], DASH score[MD=2.42, 95%CI(0.37, 4.46), P=0.02], incidence of complications[RR=0.83, 95%CI(0.71, 0.96), P=0.01], infection rate[RR=0.20, 95%CI(0.11, 0.36), P<0.000 1]between two groups. There was statistical difference in tendinitis incidence between two groups[MD=3.88, 95%CI(1.56, 9.64), P<0.003].
Conclusion: Compared with EF in treating distal radius fracture, ORIF has better clinical effects in postoperative complications, palm angle, ulnar deviation angle, ulnar variation rate and infection rate. While there were no significant difference between in DASH score, radial height, tendon rupture and carpal tunnel syndrome better EF and ORIF. For the patient pursue rapid recovery of function, ORIF is better choice. |
| KEYWORDS:Radius fractures Fracture fixation,internal External fixators 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: | 袁术鹏,张兴平,孙研,魏戌.外固定架与切开复位内固定治疗桡骨远端骨折Meta分析[J].中国骨伤,2021,34(5):429~437 |
| 英文格式: | YUAN Shu-peng,ZHANG Xing-ping,SUN Yan,WEI Xu.Meta-analysis of external fixator and open reduction and internal fixation for the treatment of distal radius fracture[J].zhongguo gu shang / China J Orthop Trauma ,2021,34(5):429~437 |
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