成人桡骨远端骨折掌侧锁定钢板固定术后的并发症：一项随机对照试验的系统评价。
Complications Following Volar Locking Plate Fixation of Distal Radius Fractures in Adults: A Systematic Review of Randomized Control Trials.
机构信息
Department of Orthopedic Surgery, University of Pittsburgh Medical Center, Pittsburgh, PA.
Duke University School of Medicine, Durham, NC.
出版信息
J Hand Surg Am. 2023 Sep;48(9):861-874. doi: 10.1016/j.jhsa.2023.04.022. Epub 2023 Aug 8.
PURPOSE
The purpose of this study was to assess the incidence of postoperative complications following volar locking plate (VLP) fixation of distal radius fractures (DRFs).
METHODS
A search using keywords and subject headings to represent the concepts of volar plating and radius fractures was generated. Databases such as MEDLINE (Ovid), Embase (Elsevier), Scopus (Elsevier), and SPORTDiscus (EBSCO) were searched from inception to November 24, 2021, for randomized controlled trials that reported complications following DRF treated with VLP. Inclusion criteria were studies with adult patients (aged ≥18 years) randomized to VLP fixation without other concomitant surgical interventions, with a minimum follow-up of 3 months. Study sample characteristics and post-surgical complications were extracted. The Cochrane Risk of Bias tool was used to evaluate quality of evidence.
RESULTS
Of the 4,059 articles identified using the search strategy, 1,778 titles/abstracts and 856 full-text articles were screened for inclusion, of which 35 articles were included for data extraction. Overall, 1,419 patients with a DRF were randomized to VLP fixation. The mean age was 60.3 years. The overall complication rate was 30.8% following VLP fixation, with 12.4% being major complications. The most common complications were median nerve-related (7.1%) and hardware removal (6.8%), secondary to other complications. Tenosynovitis was the most common tendon-related complication (3.4%). Other complications included complex regional pain syndrome (2.4%), malunion (1.3%), superficial wound infections (1.9%), and tendon rupture (1.3%).
CONCLUSIONS
A meta-analysis of high-quality studies that discuss the complications after VLP fixation for DRF showed an overall complication rate of 30.8%. VLP may be related to more hardware-related complications than those previously reported.
TYPE OF STUDY/LEVEL OF EVIDENCE: Therapeutic II.
目的
本研究旨在评估掌侧锁定板（VLP）固定桡骨远端骨折（DRF）后的术后并发症发生率。
方法
使用代表掌侧钢板和桡骨骨折概念的关键词和主题词进行搜索。从开始到 2021 年 11 月 24 日，在 MEDLINE（Ovid）、Embase（Elsevier）、Scopus（Elsevier）和 SPORTDiscus（EBSCO）等数据库中搜索了报告 VLP 治疗 DRF 后并发症的随机对照试验。纳入标准为：对成人患者（年龄≥18 岁）进行随机分组，接受 VLP 固定治疗，不进行其他伴随手术干预，随访时间至少 3 个月。提取研究样本特征和术后并发症。使用 Cochrane 偏倚风险工具评估证据质量。
结果
通过搜索策略共确定了 4059 篇文章，筛选了 1778 篇标题/摘要和 856 篇全文文章以纳入研究，其中 35 篇文章被纳入数据提取。总体而言，1419 例 DRF 患者被随机分配至 VLP 固定组。平均年龄为 60.3 岁。VLP 固定后总体并发症发生率为 30.8%，其中 12.4%为主要并发症。最常见的并发症是正中神经相关并发症（7.1%）和与硬件相关的并发症（6.8%），继发于其他并发症。腱鞘炎是最常见的肌腱相关并发症（3.4%）。其他并发症包括复杂性区域疼痛综合征（2.4%）、愈合不良（1.3%）、浅表性伤口感染（1.9%）和肌腱断裂（1.3%）。
结论
对 VLP 固定治疗 DRF 后并发症的高质量研究进行荟萃分析显示，总体并发症发生率为 30.8%。与以往报道相比，VLP 可能与更多的与硬件相关的并发症有关。
研究类型/证据水平：治疗性 II 级。
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