[外固定架与切开复位内固定治疗桡骨远端骨折的Meta分析]
[Meta-analysis of external fixator and open reduction and internal fixation for the treatment of distal radius fracture].
作者信息
Yuan Shu-Peng, Zhang Xing-Ping, Sun Yan, Wei Xu
机构信息
Wangjing Hospital of China Academy of Chinese Medical Science, Beijing 100102, China.
出版信息
Zhongguo Gu Shang. 2021 May 25;34(5):429-37. doi: 10.12200/j.issn.1003-0034.2021.05.007.
OBJECTIVE
To compare clinical efficacy and safety of plate internal fixation (ORIF) and external fixator (EF) in treating distal radius fractures by Meta-analysis.
METHODS
From establishment of database to August, 2019, randomized controlled trial (RCT) about open reduction and internal fixation (ORIF) and external fixation (EF) in treating distal radius fractures was conducted by using computer-based databases, including CNKI, VIP, Wanfang Data, Medline, Cochrane library databases. Data extraction and quality evaluation of included study according to inclusion and exclusion criteria, RevMan 5.3 software was used to perform Meta-analysis. Palm angle, ulnar deflection angle, radius height, grip strength, ulnar variation, disabilities of arm, shoulder and hand (DASH) score, total complication rate, infection rate and tendon rupture between two groups were compared.
RESULTS
Totally 19 RCT were included with 1 730 patients, 873 patients in ORIF group and 857 patients in EF group. Meta analysis result showed that after operation at 12 months, there were no significant difference in radial height [=0.04, 95%CI (-0.90, 0.99), =0.93], tendon rupture [=1.82, 95% (0.71, 4.67), =0.21], carpal tunnel syndrome [=2.15, 95%(0.98, 4.70), =0.06], complex regional pain syndrom [=0.63, 95%(0.31, 1.27)=0.78] between two groups. While there were significant difference in palm inclination angle [=1.38, 95% (0.83, 1.93), < 0.000 01], ulnar deflection angle[=0.99, 95%(0.54, 1.45), <0.000 1], ulna variability[=0.66, 95%(0.21, 1.12), =0.005], DASH score[=2.42, 95%(0.37, 4.46), =0.02], incidence of complications[=0.83, 95%(0.71, 0.96), =0.01], infection rate[=0.20, 95%(0.11, 0.36), <0.000 1]between two groups. There was statistical difference in tendinitis incidence between two groups [=3.88, 95% (1.56, 9.64), <0.003].
CONCLUSION
Compared with EF in treating distal radius fracture, ORIF has better clinical effects in postoperative complications, palm angle, ulnar deviation angle, ulnar variation rate and infection rate. While there were no significant difference between in DASH score, radial height, tendon rupture and carpal tunnel syndrome better EF and ORIF. For the patient pursue rapid recovery of function, ORIF is better choice.
目的
通过Meta分析比较钢板内固定（切开复位内固定，ORIF）与外固定架（EF）治疗桡骨远端骨折的临床疗效及安全性。
方法
自建库至2019年8月，通过计算机检索中国知网、维普、万方数据、Medline、Cochrane图书馆数据库等，收集关于切开复位内固定（ORIF）与外固定（EF）治疗桡骨远端骨折的随机对照试验（RCT）。按照纳入与排除标准进行资料提取和质量评价，采用RevMan 5.3软件进行Meta分析。比较两组间掌倾角、尺偏角、桡骨高度、握力、尺骨变异、上肢、肩部和手部功能障碍（DASH）评分、总并发症发生率、感染率及肌腱断裂情况。
结果
共纳入19项RCT，1730例患者，其中ORIF组873例，EF组857例。Meta分析结果显示，术后12个月时，两组间桡骨高度[=0.04，95%CI（-0.90，0.99），=0.93]、肌腱断裂[=1.82，95%（0.71，4.67），=0.21]、腕管综合征[=2.15，95%（0.98，4.70），=0.06]、复杂性区域疼痛综合征[=0.63，95%（0.31，1.27）=0.78]差异无统计学意义。而两组间掌倾角[=1.38，95%（0.83，1.93），<0.000 01]、尺偏角[=0.99，95%（0.54，1.45），<0.000 1]、尺骨变异[=0.66，95%（0.21，1.12），=0.005]、DASH评分[=2.42，95%（0.37，4.46），=0.02]、并发症发生率[=0.83，95%（0.71，0.96），=0.01]、感染率[=0.20，95%（0.11，0.36），<0.000 1]差异有统计学意义。两组间肌腱炎发生率差异有统计学意义[=3.88，95%（1.56，9.64），<0.003]。
结论
与外固定架治疗桡骨远端骨折相比，切开复位内固定在术后并发症、掌倾角、尺偏角、尺骨变异率及感染率方面临床效果更好。而在DASH评分、桡骨高度、肌腱断裂及腕管综合征方面外固定架与切开复位内固定差异无统计学意义。对于追求功能快速恢复的患者，切开复位内固定是更好的选择。
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