Zhang Qingyu, Liu Fanxiao, Xiao Zhenyun, Li Zhenfeng, Wang Bomin, Dong Jinlei, Han Yong, Zhou Dongsheng, Li Jianmin
From the Department of Orthopedics (QZ, ZL, JL), Qilu Hospital, Shandong University, Jinan, Shandong; Department of Orthopedics (FL, BW, DZ, JD, YH), Shandong Provincial Hospital Affiliated to Shandong University, Jinan, Shandong; and Department of Joint Surgery (ZX), Heze Municipal Hospital, Heze, Shandong, China.
Medicine (Baltimore). 2016 Mar;95(9):e2945. doi: 10.1097/MD.0000000000002945.
Although a serious of meta-analyses have been published to compare the effects of internal versus external fixation (IF vs EF) for treating distal radial fractures (DRF), no consensus was obtained.B y performing a systematic review of overlapping meta-analyses comparing IF versus EF for the treatment of distal radial fractures, we attempted to evaluate the methodology and reporting quality of these meta-analyses, interpret the source of discordant results, and therefore determine the dominant strategy for the treatment of distal radial fractures based on the best evidence currently. An electronic databases search was conducted in MEDLINE, Embase, and Cochrane library to retrieve meta-analyses comparing IF versus EF for treating DRF. Reference lists of relevant literatures were also screened manually to retrieve additional ones. Two investigators independently assessed the eligibility of retrieved articles using predefined inclusion and exclusion criteria. All characteristics as well as outcome variables including functional outcomes, range of motion, radiological results, and complication rates with relevant heterogeneity information presented in each included study were extracted. Heterogeneity was thought to be significant when I² > 50%. We adopted the Oxford Levels of Evidence and the Assessment of Multiple Systematic Reviews (AMSTAR) Instrument to assess the methodological quality of every included study, and applied the Jadad decision algorithm to select studies with more likely reliable conclusions. A total of 8 studies met the inclusion criteria. The AMSTAR scores ranged from 5 to 9 with a median of 7.75. Following the Jadad algorithm, the meta-analyses with most reliable results can be selected based on the search strategies and application of selection. Finally, 2 meta-analyses with most RCTs and highest AMSTAR scores were selected in this systematic review of overlapping meta-analysis. The best available evidence suggested that compared with EF, IF was significantly associated with lower Disabilities of the Arm, Shoulder and Hand (DASH) scores, better rehabilitation of volar tilt and radial inclination, and lower infection rate at 1-year follow-up. Therefore, we could conclude that internal fixation is superior to external fixations for the treatment of distal radial fractures.
尽管已经发表了一系列荟萃分析来比较内固定与外固定（IF vs EF）治疗桡骨远端骨折（DRF）的效果，但尚未达成共识。通过对比较IF与EF治疗桡骨远端骨折的重叠荟萃分析进行系统评价，我们试图评估这些荟萃分析的方法学和报告质量，解释结果不一致的原因，并因此根据目前的最佳证据确定治疗桡骨远端骨折的主要策略。在MEDLINE、Embase和Cochrane图书馆中进行了电子数据库搜索，以检索比较IF与EF治疗DRF的荟萃分析。还手动筛选了相关文献的参考文献列表以检索其他文献。两名研究人员使用预先定义的纳入和排除标准独立评估检索到的文章的合格性。提取每个纳入研究中呈现的所有特征以及结果变量，包括功能结果、活动范围、放射学结果和并发症发生率以及相关的异质性信息。当I²>50%时，认为异质性显著。我们采用牛津证据水平和多重系统评价评估（AMSTAR）工具来评估每个纳入研究的方法学质量，并应用Jadad决策算法选择结论更可能可靠的研究。共有8项研究符合纳入标准。AMSTAR评分范围为5至9，中位数为7.75。根据Jadad算法，可以根据搜索策略和选择应用选择结果最可靠的荟萃分析。最后，在这项重叠荟萃分析的系统评价中选择了2项随机对照试验最多且AMSTAR评分最高的荟萃分析。现有最佳证据表明，与EF相比，IF与较低的手臂、肩部和手部功能障碍（DASH）评分、掌倾角和桡偏角更好的恢复以及1年随访时较低的感染率显著相关。因此，我们可以得出结论，内固定在治疗桡骨远端骨折方面优于外固定。
