Nema Sandeep Kumar, Austine Jose, Ramasubramani Premkumar, Agrawal Ruchin
Department of Orthopaedics, All India Institute of Medical Sciences, Raipur, Chhattisgarh, India.
Trauma and Orthopaedics, Portsmouth Hospitals University NHS Trust, Portsmouth Hospitals University, Portsmouth, UK.
J Emerg Trauma Shock. 2023 Apr-Jun;16(2):35-42. doi: 10.4103/jets.jets_157_22. Epub 2023 May 25.
This systematic review aims to determine the relative risk of distal radius (Colles) fracture (DRF) malalignment between ultrasound (USG)-guided and conventional/landmark guided/blind manipulation and reduction (M&R).
We searched 3932 records from major electronic bibliographic databases on USG-guided manipulation of DRF. Studies with randomized, quasi-randomized, and cross-sectional study designs meeting the inclusion criteria were included in this review. USG and landmark-guided DRF manipulations were named cases and controls, respectively. The Newcastle-Ottawa Scale was used to assess the quality of included studies.
Thirteen and nine studies were analysed for qualitative and quantitative analysis in this review. Nine hundred fifty-one DRF patients (475 cases and 476 controls) from 9 studies with mean ages of 51.52 ± 11.86 (22-92) and 55.82 ± 11.28 (18-98) years for cases and controls were pooled for this review. The pooled relative risk estimate from the studies included in the meta-analysis was 0.90 (0.74-1.09). There was a 10% decrease in the risk of malalignment with USG than the landmark guided M&R of DRF. The statistic estimated a heterogeneity of 83%. Sensitivity analysis revealed a relative risk of 1.00 (0.96-1.05).
The USG-guided manipulation does not prevent malalignment over the landmark-based manipulation of DRF. The risk of bias across the included studies and heterogeneity of 83% mandates further unbiased, high-quality studies to verify the findings of this review.
本系统评价旨在确定超声（USG）引导下与传统/地标引导/盲目手法复位（M&R）治疗桡骨远端（科雷氏）骨折（DRF）时骨折对位不良的相对风险。
我们在主要电子文献数据库中检索了3932条关于USG引导下DRF手法复位的记录。纳入本评价的研究包括符合纳入标准的随机、半随机和横断面研究设计。USG引导和地标引导的DRF手法复位分别命名为病例组和对照组。采用纽卡斯尔-渥太华量表评估纳入研究的质量。
本评价对13项和9项研究进行了定性和定量分析。来自9项研究的951例DRF患者（475例病例组和476例对照组）被纳入本评价，病例组和对照组的平均年龄分别为51.52±11.86岁（22 - 92岁）和55.82±11.28岁（18 - 98岁）。荟萃分析中纳入研究的合并相对风险估计值为0.90（0.74 - 1.09）。与地标引导的DRF手法复位相比，USG引导下对位不良的风险降低了10%。统计分析估计异质性为83%。敏感性分析显示相对风险为1.00（0.96 - 1.05）。
USG引导下的手法复位并不能比基于地标的DRF手法复位更好地预防对位不良。纳入研究中存在的偏倚风险和83%的异质性要求进行进一步的无偏倚、高质量研究以验证本评价的结果。
