Yamamoto Michiro, Fujihara Yuki, Fujihara Nasa, Hirata Hitoshi
Department of Hand Surgery, Nagoya University Graduate School of Medicine, 65 Tsurumai-cho, Showa-ku, Nagoya 466-8550, Japan.
Department of Hand Surgery, Nagoya University Graduate School of Medicine, 65 Tsurumai-cho, Showa-ku, Nagoya 466-8550, Japan.
Injury. 2017 Dec;48(12):2650-2656. doi: 10.1016/j.injury.2017.10.010. Epub 2017 Oct 9.
Indication of volar locking plate (VLP) removal after bony healing of distal radius fracture (DRF) is controversial. Studies with various range of removal rate were reported. The purpose of this systematic review was to investigate the frequency and the reasons of hardware removal over the world. We hypothesized that more frequent VLP removal contribute to better clinical outcomes.
The authors searched all available literature in the PubMed and EMBASE databases for articles reporting on outcomes of treatment using VLP for DRF. Data collection included hardware removal rate, complication rate, clinical and radiological outcomes. We analyzed correlation between hardware removal rate with clinical and radiological outcomes.
A total of 3472 articles were screened, yielding 52 studies for final review. The mean hardware removal rate was 9%, ranging from 0 to 100%. The mean removal rate in studies from France, Norway, Japan, and Belgium was as high as 19%. The mean removal rate in studies from the US was low (3%). The most frequent reasons for extraction were routine removal (22%), tendon irritation or tenosynovitis (14%), hardware problem (14%), and patient' request (13%). Although routine removal and patient' request were not counted as complication, correlation between removal rate with complication rate was strong (rho=0.64, p<0.001). Correlations between clinical and radiological outcomes were week except for volar tilt (rho=-0.42, p=0.009).
There was a diversity of removal rate and reasons in the studies over the world. High frequent VLP removal did not contribute to better clinical outcomes.
桡骨远端骨折（DRF）骨性愈合后掌侧锁定钢板（VLP）取出的指征存在争议。已有报道显示不同研究的取出率范围各异。本系统评价的目的是调查全球范围内钢板取出的频率及原因。我们假设更频繁地取出VLP有助于获得更好的临床疗效。
作者检索了PubMed和EMBASE数据库中所有关于使用VLP治疗DRF的报道文章。数据收集包括钢板取出率、并发症发生率、临床和影像学结果。我们分析了钢板取出率与临床和影像学结果之间的相关性。
共筛选出3472篇文章，最终纳入52项研究进行综述。钢板平均取出率为9%，范围从0至100%。来自法国、挪威、日本和比利时的研究中平均取出率高达19%。来自美国的研究中平均取出率较低（3%）。最常见的取出原因是常规取出（22%）、肌腱刺激或腱鞘炎（14%）、钢板问题（14%）以及患者要求（13%）。尽管常规取出和患者要求不算作并发症，但取出率与并发症发生率之间的相关性很强（rho = 0.64，p < 0.001）。除掌倾角外（rho = -0.42，p = 0.009），临床和影像学结果之间的相关性较弱。
全球范围内的研究中取出率和原因存在多样性。高频率取出VLP并未有助于获得更好的临床疗效。
