Department of Orthopedics, the First Hospital of Jilin University, Changchun, Street Xinmin 71, China.
Department of Orthopedics, the Eleventh Hospital of Shanxi Medical University, Xinjian South Road, Yingze District, China.
Osteoporos Int. 2023 Apr;34(4):659-669. doi: 10.1007/s00198-022-06649-8. Epub 2022 Dec 20.
This articl e includes high-quality randomized controlled trials in recent years and updates the past meta-analysis. It has been proved that cast immobilization can achieve similar functional results, reduce economic burden in the long-term compared with surgery, and provide a basis for doctors to make treatment choices.
The efficacy of conservative and surgical treatment of distal radius fractures (DRFs) in adults is still controversial. Recently, some high-quality randomized controlled trials (RCTs) evaluated the efficacy of both treatments. We hypothesized that treatment of DRFs with closed reduction and cast immobilization would achieve functional outcomes similar to surgery.
This study is a systematic review and summary of RCTs comparing conservative and surgical management of DRFs from 2005 to March 2022. Patients were evaluated for functional and imaging outcomes and complications.
A total of 11 studies [1-11] included 1775 cases of DRFs. At 1-year follow-up, the cast group had lower mean differences (MDs) in DASH scores than the surgery group by - 2.55 (95% CI = - 5.02 to - 0.09, P = 0.04); with an MD of 1.63 (95% CI = 1.08-2.45, P = 0.02), while the surgery group had a lesser complication rate than the cast group.
At 1-year follow-up, the lower DASH scores of the cast group showed advantages of this treatment, but the complication rate was higher than that of the surgery group. There was no massive distinction in other scoring methods.
本文包含近年来高质量的随机对照试验，并更新了过去的荟萃分析。已经证明，石膏固定可以获得相似的功能结果，与手术相比在长期内减轻经济负担，并为医生做出治疗选择提供依据。
成人桡骨远端骨折（DRF）的保守和手术治疗效果仍存在争议。最近，一些高质量的随机对照试验（RCT）评估了这两种治疗方法的效果。我们假设，闭合复位和石膏固定治疗 DRF 可获得与手术相似的功能结果。
本研究是一项对 2005 年至 2022 年 3 月间比较保守和手术治疗 DRF 的 RCT 进行系统评价和总结的研究。对患者的功能和影像学结果以及并发症进行评估。
共纳入 11 项研究[1-11]，包括 1775 例 DRF 患者。在 1 年随访时，与手术组相比，石膏组 DASH 评分的平均差值（MD）更小，为 - 2.55（95% CI = - 5.02 至 - 0.09，P = 0.04）；MD 为 1.63（95% CI = 1.08-2.45，P = 0.02），而手术组的并发症发生率低于石膏组。
在 1 年随访时，石膏组较低的 DASH 评分表明这种治疗具有优势，但并发症发生率高于手术组。在其他评分方法上没有明显区别。
