Emergency Medicine, Royal Devon and Exeter NHS Foundation Trust, Exeter, UK
Emergency Department, Royal Devon and Exeter Foundation Trust, Exeter, UK.
Emerg Med J. 2021 Jul;38(7):537-542. doi: 10.1136/emermed-2020-210464. Epub 2021 Apr 14.
To conduct a systematic review of the clinical literature to determine whether ultrasound can be used to improve the reduction of distal radius fractures in adults in the ED.
A study protocol was registered on PROSPERO. EMBASE, PubMed/MEDLINE, the Cochrane Central Register of Controlled Trials and ClinicalTrials.gov of the US National Library of Medicine were searched for studies evaluating ultrasound-assisted distal radial fracture reductions in comparison with standard care. The primary outcome of interest was manipulation success rates, defined as the proportion of fracture manipulations resulting in acceptable anatomical alignment, with secondary outcome being subsequent surgical intervention rates in ultrasound and standard care group of patients.
248 were screened at title and abstract, and 10 studies were included for a narrative synthesis. The quality of this evidence is limited but suggests ultrasound is accurate in determining distal radius fracture reduction and may improve the quality of reduction compared with standard care. However, there is insufficient evidence to determine whether this affects the rate of subsequent surgical intervention or functional outcome.
There is a lack of evidence that using ultrasound in the closed reduction of distal radius fractures benefits patients. Properly conducted randomised controlled trials with patient-orientated outcomes are crucial to investigate this technology.
系统回顾临床文献，以确定超声检查是否可用于提高急诊科成人桡骨远端骨折的复位效果。
研究方案已在 PROSPERO 上注册。检索 EMBASE、PubMed/MEDLINE、Cochrane 中央对照试验注册库和美国国立医学图书馆的 ClinicalTrials.gov，评估超声辅助与常规护理比较治疗桡骨远端骨折复位的研究。主要观察指标为复位成功率，定义为可接受的解剖对位骨折复位操作的比例，次要观察指标为超声和常规护理组患者的后续手术干预率。
在标题和摘要层面，共筛选出 248 篇文献，纳入 10 项研究进行叙述性综合分析。该证据的质量有限，但表明超声在确定桡骨远端骨折复位方面是准确的，并且可能比常规护理更好地改善复位质量。然而，目前尚无足够证据确定这是否会影响后续手术干预或功能结局的发生率。
目前尚无证据表明在桡骨远端骨折的闭合复位中使用超声对患者有益。开展以患者为导向的结局为重点的恰当设计的随机对照试验对于研究该技术至关重要。
