Wang Jie, Lu Yandong, Cui Yujie, Wei Xuelei, Sun Jie
Department of Orthopaedic Traumatology, Tianjin Hospital, Tianjin, China.
Department of Orthopaedic Traumatology, Tianjin Hospital, Tianjin, China.
Acta Orthop Traumatol Turc. 2018 Sep;52(5):334-342. doi: 10.1016/j.aott.2018.06.001. Epub 2018 Jun 29.
The aim of this meta-analysis of randomized controlled trials (RCT) and retrospective cohort studies (CS) regarding the use of volar locking plate (VLP) and external fixation (EF) in distal radius fractures was to determine whether there was any evidence that one treatment was superior to the other.
The meta-analysis followed the Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) guidelines. Electrical databases (PubMed, EMBASE and the Cochrane library) were retrieved to find RCTs and CSs met the eligibility criteria. Two reviewers screened the studies, extracted the data and evaluated the methodological quality, and performed data analysis with RevMan 5.1. The publication bias was test by Stata 14.0. The Begg's and Egger's test were performed by Stata 14.0. The quality of evidence was graded according to the criteria of GRADE. We ultimately included ten RCTs and eleven CSs.
A total of 1590 subjects were reported. Publication bias was detected by funnel plot in RCTs. VLP could provide better results such as DASH scores (RCT: MD = -6.12, 95%CI = -12.07-0.17; CS: MD = -6.43, 95%CI = -12.53-0.3), ulnar variance (RCT: MD = -0.81, 95%CI = -1.25-0.37) and infection rate (RCT: RR = 0.25, 95%CI = 0.10-0.65; CS: RR = 0.15, 95%CI = 0.06-0.40). There were no significant differences for G-W scores, VAS and grip strength between the VLP group and EF group. There was significantly greater loss of volar tilt (P = 0.01) and radial inclination (P = 0.02) in patients receiving EF, basing on the CSs.
VLP could provide better results, such as DASH scores, ulnar variance, volar tilt, radial inclination and infection rate. The use of VLP appear to be associated with better results of ROM (flexion, pronation, supination and radial deviation), radiographic parameters (volar tilt and radial inclination) and lower total complication rate and CRPS rate in CSs.
Level 1, Therapeutic study.
本荟萃分析纳入了关于桡骨远端骨折使用掌侧锁定钢板（VLP）和外固定（EF）的随机对照试验（RCT）及回顾性队列研究（CS），旨在确定是否有证据表明一种治疗方法优于另一种。
该荟萃分析遵循系统评价和荟萃分析的首选报告项目（PRISMA）指南。检索电子数据库（PubMed、EMBASE和Cochrane图书馆）以查找符合纳入标准的RCT和CS。两名研究者筛选研究、提取数据并评估方法学质量，然后使用RevMan 5.1进行数据分析。采用Stata 14.0检验发表偏倚。通过Stata 14.0进行Begg检验和Egger检验。根据GRADE标准对证据质量进行分级。最终纳入了10项RCT和11项CS。
共报告了1590名受试者。通过漏斗图在RCT中检测到发表偏倚。VLP能提供更好的结果，如DASH评分（RCT：MD = -6.12，95%CI = -12.07 - 0.17；CS：MD = -6.43，95%CI = -12.53 - 0.3）、尺骨变异（RCT：MD = -0.81，95%CI = -1.25 - 0.37）和感染率（RCT：RR = 0.25，95%CI = 0.10 - 0.65；CS：RR = 0.15，95%CI = 0.06 - 0.40）。VLP组和EF组在G-W评分、VAS和握力方面无显著差异。基于CS，接受EF治疗的患者掌侧倾斜度（P = 0.01）和桡骨倾斜度（P = 0.02）的丢失明显更大。
VLP能提供更好的结果，如DASH评分、尺骨变异、掌侧倾斜度、桡骨倾斜度和感染率。在CS中，使用VLP似乎与更好的ROM（屈曲、旋前、旋后和桡偏）结果、影像学参数（掌侧倾斜度和桡骨倾斜度）以及更低的总并发症发生率和CRPS发生率相关。
1级，治疗性研究。
