Division of Public Health (A.P.P. and C.Z.), Eccles Health Sciences Library (M.M.M.), Department of Orthopaedics (A.R.T. and N.H.K.), and School of Medicine (A.R.S.), University of Utah, Salt Lake City, Utah.
Division of Orthopaedic and Trauma Surgery, Department of Surgery, Oulu University Hospital, Oulu, Finland.
J Bone Joint Surg Am. 2020 Jul 15;102(14):1280-1288. doi: 10.2106/JBJS.19.01442.
It remains unclear whether volar locked plating (VLP) yields a better functional outcome than closed reduction and casting (CRC) for elderly patients with an acute, displaced distal radial fracture. Our purpose was to conduct a systematic review and meta-analysis of randomized controlled trials comparing outcomes of VLP and CRC for elderly patients (age, ≥60 years).
Multiple databases, including MEDLINE, were searched for randomized controlled trials evaluating outcomes following distal radial fracture treatment. Raw data were obtained for studies that included patients of all ages, and the elderly subgroup was included for analysis. The primary outcome was the Disabilities of the Arm, Shoulder and Hand (DASH) score at ≥1 year of follow-up. Secondary outcomes included the 3-month DASH score, range of motion, final radiographic alignment, and complications. Effect sizes for the comparison of each outcome between groups were pooled across studies using random-effects models with the inverse variance weighting method. Changes in DASH score were compared with a minimal clinically important difference (MCID) estimate of 10 to assess clinical relevance.
Of 2,152 screened articles, 6 were included. Demographics were similar for the 274 VLP and 287 CRC patients. DASH scores were significantly better following VLP than CRC at the time of final follow-up (12 to 24 months postoperatively; score difference, -5.9; 95% confidence interval [CI], -8.7 to -3.1) and at 3 months (-8.9; 95% CI, -13.0 to -4.8). VLP yielded significantly better palmar tilt, radial inclination, and supination, with no differences in ulnar variance, flexion-extension, pronation, or total complication rates.
Functional outcome was significantly better following VLP than CRC 3 months into the treatment of acute, displaced distal radial fractures in an elderly population and up to 2 years after injury. However, the observed differences in the final DASH score did not exceed published estimates of the MCID, suggesting that clinical outcomes are similar for both treatment options.
Therapeutic Level I. See Instructions for Authors for a complete description of levels of evidence.
目前尚不清楚掌侧锁定钢板（VLP）与闭合复位和石膏固定（CRC）相比，对于老年急性桡骨远端骨折患者在功能预后上是否更优。我们的目的是对比较 VLP 和 CRC 治疗老年患者（年龄≥60 岁）桡骨远端骨折结果的随机对照试验进行系统评价和荟萃分析。
我们检索了 MEDLINE 等多个数据库，以评估桡骨远端骨折治疗后结果的随机对照试验。对于纳入所有年龄段患者的研究，我们获取了原始数据，并对老年亚组进行了分析。主要结局是≥1 年随访时的上肢功能障碍（DASH）评分。次要结局包括 3 个月时的 DASH 评分、活动范围、最终放射影像学对线和并发症。使用随机效应模型和倒数方差加权法，对各组间各项结局的效应量进行了跨研究的汇总。通过与 10 分的最小临床重要差异（MCID）估计值比较来评估 DASH 评分变化的临床意义。
在筛选出的 2152 篇文章中，有 6 篇符合纳入标准。274 例 VLP 患者和 287 例 CRC 患者的人口统计学特征相似。在最终随访（术后 12 至 24 个月）和 3 个月时，VLP 组的 DASH 评分明显优于 CRC 组（差值分别为-5.9；95%置信区间[CI]，-8.7 至-3.1；差值为-8.9；95%CI，-13.0 至-4.8）。VLP 组的掌倾角、桡骨倾斜角和旋后角度明显更好，而尺侧偏移、屈伸、旋前和总并发症发生率无差异。
在老年桡骨远端骨折患者的治疗中，VLP 在治疗后 3 个月和受伤后 2 年内的功能预后明显优于 CRC。然而，最终 DASH 评分的差异未超过已发表的 MCID 估计值，这表明两种治疗方案的临床结局相似。
治疗性等级 I。有关证据等级的完整描述，请参见作者须知。
