切开复位内固定与外固定治疗不稳定桡骨远端骨折的并发症：通过荟萃分析对证据进行分级。
Complications following open reduction and internal fixation versus external fixation in treating unstable distal radius fractures: Grading the evidence through a meta-analysis.
机构信息
Department of Integrated Traditional Chinese and Western Medicine, Tianjin Hospital, Tianjin, China.
Graduate School, Tianjin Medical University, Tianjin, China; Department of Orthopaedics, Tianjin Hospital, Tianjin, China.
出版信息
Orthop Traumatol Surg Res. 2018 Feb;104(1):95-103. doi: 10.1016/j.otsr.2017.08.020. Epub 2017 Oct 12.
BACKGROUND
The common fixation techniques for unstable distal radius fractures include open reduction and internal fixation (ORIF) with plates and closed reduction and external fixation (EF). There is controversy over the choice of surgical approach in treating unstable distal radius fractures.
HYPOTHESIS
This meta-analysis was performed to compare complication rates in patients treated with ORIF or EF for unstable distal radius fractures and to develop GRADE (grading of recommendations, assessment, development, and evaluation)-based recommendations for using the procedures to treat unstable distal radius fractures.
MATERIALS AND METHODS
A systematic search of all the studies published was conducted using the Pubmed, ScienceDirect, Embase, BIOSIS, Springer, Cochrane Library databases. The randomized controlled trials (RCTs) that compared ORIF with EF in treating adult patients with unstable distal radius fractures and provided data regarding the complication were identified. The demographic characteristics and adverse events were manually extracted from all of the included studies. RevMan 5.1 was used for data analysis. PRISMA guidelines were followed.
RESULTS
Sixteen studies that included a total of 1280 patients met the inclusion criteria. Compared with ORIF, EF results in higher incidence of total complications, infection and malunion. The overall GRADE system evidence quality was very low, which reduces our confidence in the recommendations of this system.
DISCUSSION
This meta-analysis indicates that ORIF and EF are both effective procedures for treating unstable distal radius fractures. ORIF may be superior to EF in the treatment of unstable distal radius fractures. Because of the low quality evidence currently available, high-quality RCTs are required.
LEVEL OF EVIDENCE
Level II: low-powered prospective randomized trial meta-analysis.
背景
不稳定型桡骨远端骨折的常见固定技术包括切开复位内固定（ORIF）和钢板固定以及闭合复位外固定（EF）。在治疗不稳定型桡骨远端骨折时，手术入路的选择存在争议。
假说
本荟萃分析旨在比较 ORIF 和 EF 治疗不稳定型桡骨远端骨折的并发症发生率，并为使用这些方法治疗不稳定型桡骨远端骨折制定基于 GRADE（推荐分级、评估、发展和评价）的建议。
材料和方法
使用 Pubmed、ScienceDirect、Embase、BIOSIS、Springer、Cochrane Library 数据库对所有已发表的研究进行系统搜索。确定了比较 ORIF 和 EF 治疗成人不稳定型桡骨远端骨折并提供并发症数据的随机对照试验（RCT）。手动从所有纳入的研究中提取人口统计学特征和不良事件。使用 RevMan 5.1 进行数据分析。遵循 PRISMA 指南。
结果
符合纳入标准的共有 16 项研究，共纳入 1280 例患者。与 ORIF 相比，EF 导致总并发症、感染和畸形愈合的发生率更高。整体 GRADE 系统证据质量为极低，这降低了我们对该系统建议的信心。
讨论
本荟萃分析表明，ORIF 和 EF 都是治疗不稳定型桡骨远端骨折的有效方法。ORIF 在治疗不稳定型桡骨远端骨折方面可能优于 EF。由于目前可用的证据质量较低，需要进行高质量的 RCT。
证据水平
II 级：低效能前瞻性随机试验荟萃分析。
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