Michael Reinemary, Nakhouzi Andréa, Kahhaleh Edward, Pelet Stéphane
CHU de Québec-Hôpital Enfant-Jésus, 1401, 18ème Rue, Québec (QC) Canada G1J1Z4.
Centre de Recherche du CHU de Québec - Axe Médecine Régénératrice.
J Hand Surg Glob Online. 2023 May 18;5(5):589-594. doi: 10.1016/j.jhsg.2023.04.009. eCollection 2023 Sep.
We performed a systematic review and meta-analysis to compare the efficacy of volar locking plating (VLP) to conservative treatment in distal radius fractures in patients aged >60 years old.
English articles were searched in electronic databases including MEDLINE, CENTRAL, Embase, Web of science, and ClinicalTrial.gov from inception to October 2020. Relevant article reference lists also were reviewed. Two reviewers independently screened and extracted data from trials comparing VLP to nonsurgical treatment in distal radial fractures in the elderly. Starting with 3052 citations, 5 trials (539 patients) met the inclusion criteria. The primary outcomes were disabilities of the arm, shoulder, and hand, and patient-rated wrist evaluation scores, grip strength, and range of motion.
All trials of this random effect meta-analysis were at a moderate risk of bias due to the lack of blinding. Differences in the disabilities of the arm, shoulder, and hand score (mean difference [MD] -5,91; 95% confidence interval [CI], -8,83; -3,00), patient-rated wrist evaluation score (MD -9.07; 95% CI, -14.57, -3.57), and grip strength (MD 5,12; 95% CI, 0,59-9,65) were statistically significant and favored VLPs, however without reaching clinical significance. No effect was observed in terms of the range of motion and reoperation rates.
This review was not able to demonstrate any clinical benefit to the surgical treatment of distal radius fractures with VLP in patients aged >60 years old compared to nonsurgical treatment.
TYPE OF STUDY/LEVEL OF EVIDENCE: Therapeutic I.
我们进行了一项系统评价和荟萃分析，以比较掌侧锁定钢板（VLP）与保守治疗对60岁以上桡骨远端骨折患者的疗效。
检索了电子数据库（包括MEDLINE、CENTRAL、Embase、Web of science和ClinicalTrial.gov）中从数据库建立至2020年10月的英文文章。还对相关文章的参考文献列表进行了审查。两名研究者独立筛选并提取了比较VLP与非手术治疗老年桡骨远端骨折的试验数据。从3052篇文献开始筛选，5项试验（539例患者）符合纳入标准。主要结局指标为上肢、肩部和手部功能障碍，患者自评腕关节评估评分、握力和活动范围。
由于缺乏盲法，该随机效应荟萃分析的所有试验均存在中度偏倚风险。上肢、肩部和手部功能障碍评分（平均差[MD]-5.91；95%置信区间[CI]，-8.83；-3.00）、患者自评腕关节评估评分（MD -9.07；95%CI，-14.57，-3.57）和握力（MD 5.12；95%CI，0.59-9.65）的差异具有统计学意义，且支持VLP治疗，但未达到临床意义。在活动范围和再次手术率方面未观察到效果。
本综述未能证明与非手术治疗相比，60岁以上桡骨远端骨折患者采用VLP手术治疗有任何临床益处。
研究类型/证据水平：治疗性I级。
