成人桡骨远端骨折掌侧锁定钢板固定与闭合复位的系统评价和Meta分析

Volar Locking Plate Fixation Versus Closed Reduction for Distal Radial Fractures in Adults: A Systematic Review and Meta-Analysis.

作者信息

Lawson Andrew, Na Michael, Naylor Justine M, Lewin Adriane M, Harris Ian A

机构信息

Whitlam Orthopaedic Research Centre, Ingham Institute for Applied Medical Research, South Western Sydney Clinical School, University of New South Wales (UNSW) Australia, Sydney, New South Wales, Australia.

出版信息

JBJS Rev. 2021 Jan 20;9(1):e20.00022. doi: 10.2106/JBJS.RVW.20.00022.

DOI:10.2106/JBJS.RVW.20.00022

PMID:33512973

Abstract

BACKGROUND

Distal radial fractures in adults are common, representing a substantial burden to patients and health systems. The 2 main treatments are closed reduction and cast immobilization (CR) and volar locking plate (VLP) fixation. Our primary aim was to determine if VLP fixation leads to better patient-reported pain and function at 12 months compared with CR.

METHODS

We searched systematically for randomized controlled trials (RCTs) comparing outcomes of VLP fixation with CR for the treatment of distal radial fractures in adults. The Cochrane Collaboration risk-of-bias tool was used to assess the methodological quality of each study. Meta-analyses of patient-reported outcomes, clinical outcomes, and complications were performed. Key findings were assessed using the Grading of Recommendations, Assessment, Development and Evaluation (GRADE) approach.

RESULTS

A total of 8 RCTs (810 participants) were eligible for inclusion. Based on moderate-certainty evidence, no clinically important differences in patient-reported pain and function were found: although the mean difference (MD) in the Disabilities of the Arm, Shoulder and Hand (DASH) score at 12 months was 4.1 points (95% confidence interval [CI], 1.2 to 7.0 points) in favor of VLP fixation, this was well below the minimum clinically important difference of 10 points. There was low-certainty evidence that VLP fixation led to better Patient-Rated Wrist Evaluation (PRWE) scores at 12 months (MD, 6.9 points; 95% CI, -0.6 to 14.3 points) and better DASH scores at 24 months (MD, 8.9 points; 95% CI, 5.8 to 12.1 points) but again, these differences were not clinically important. There was very low or low-certainty evidence that VLP fixation provided better long-term radiographic outcomes, including palmar tilt (MD, 6.5°; 95% CI, 2.8° to 10.1°), radial inclination (MD, 3.4°; 95% CI, 2.5° to 4.3°), and ulnar variance (MD, 0.7 mm; 95% CI, -0.8 to 2.1 mm).

CONCLUSIONS

There were no clinically important differences between treatments with respect to patient-reported pain and function at 12 months post-treatment, even though VLP fixation resulted in better fracture alignment than CR.

LEVEL OF EVIDENCE

Therapeutic Level II. See Instructions for Authors for a complete description of levels of evidence.

摘要

背景

成人桡骨远端骨折很常见，给患者和医疗系统带来沉重负担。两种主要治疗方法是闭合复位及石膏固定（CR）和掌侧锁定钢板（VLP）固定。我们的主要目的是确定与CR相比，VLP固定在12个月时是否能使患者报告的疼痛和功能更好。

方法

我们系统检索了比较VLP固定与CR治疗成人桡骨远端骨折疗效的随机对照试验（RCT）。使用Cochrane协作网偏倚风险工具评估每项研究的方法学质量。对患者报告的结局、临床结局和并发症进行荟萃分析。使用推荐分级、评估、制定与评价（GRADE）方法评估主要研究结果。

结果

共有8项RCT（810名参与者）符合纳入标准。基于中等确定性证据，未发现患者报告的疼痛和功能有临床重要差异：尽管12个月时手臂、肩部和手部功能障碍（DASH）评分的平均差值（MD）为4.1分（95%置信区间[CI]，1.2至7.0分），有利于VLP固定，但这远低于10分的最小临床重要差异。有低确定性证据表明，VLP固定在12个月时能使患者腕关节评估（PRWE）评分更好（MD，6.9分；95%CI，-0.6至14.3分），在24个月时能使DASH评分更好（MD，8.9分；95%CI，5.8至12.1分），但同样，这些差异在临床上并不重要。有极低或低确定性证据表明，VLP固定能提供更好的长期影像学结局，包括掌倾角（MD，6.5°；95%CI，2.8°至10.1°）、桡偏角（MD，3.4°；95%CI，2.5°至4.3°）和尺骨变异（MD，0.7mm；95%CI，-0.8至2.1mm）。