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关节镜辅助下桡骨远端骨折的手术治疗:一项系统评价与Meta分析

Arthroscopic Assistance in Surgical Management of Distal Radius Fractures: A Systematic Review and Meta-analysis.

作者信息

Román-Veas Javier, Gutiérrez-Espinoza Héctor, Campos-Jara Christian, Martínez-García Darío

机构信息

Clínica Indisa, Santiago, Chile.

Escuela de Fisioterapia, Universidad de las Américas, Quito, Ecuador.

出版信息

J Wrist Surg. 2022 Oct 13;13(1):86-95. doi: 10.1055/s-0042-1757768. eCollection 2024 Feb.

DOI:10.1055/s-0042-1757768
PMID:38264129
原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC10803148/
Abstract

Wrist arthroscopy has become a commonly used tool for the management of adults with distal radius fractures (DRFs), although its implementation requires technical competence. This systematic review and meta-analysis appraised the available evidence concerning the contribution of wrist arthroscopy to the functional and radiological outcomes of patients with DRFs operated with arthroscopic assistance.  Randomized control trials were identified through five principal electronic databases on May 31, 2022: Web of Science, Scopus, EBSCO, Embase, and PubMed. Two authors independently performed the search and data extraction and assessed risk of bias (RoB) using the Cochrane RoB tool.  A total of 1,780 relevant abstracts and citations were extracted in the preliminary search, which yielded 6 trials that met the eligibility criteria, and 3 studies were included in the quantitative synthesis. The overall pooled mean difference (MD) estimate showed no significant difference in the Disabilities of the Arm, Shoulder, and Hand scores between surgical groups with and without arthroscopic assistance (MD = 0.77 points, 95% confidence interval = -6.58 to 5.03,  = 0.79), with substantial heterogeneity (I  = 85%).  There was low-quality evidence that wrist arthroscopy conveyed not clinically or statistically significant difference to functional outcomes of patients with DRFs. However, our findings are limited by the numbers of studies included and lack of long-term follow-up, although they do provide a good starting point for future quality research.

摘要

腕关节镜检查已成为治疗成人桡骨远端骨折(DRF)的常用工具,尽管其实施需要技术能力。本系统评价和荟萃分析评估了关于腕关节镜检查对在关节镜辅助下手术的DRF患者功能和影像学结果贡献的现有证据。

2022年5月31日,通过五个主要电子数据库(科学网、Scopus、EBSCO、Embase和PubMed)检索随机对照试验。两名作者独立进行检索和数据提取,并使用Cochrane偏倚风险(RoB)工具评估偏倚风险。

初步检索共提取了1780篇相关摘要和引文,其中6项试验符合纳入标准,3项研究纳入定量综合分析。总体合并平均差(MD)估计显示,在有无关节镜辅助的手术组之间,手臂、肩部和手部残疾评分无显著差异(MD = 0.77分,95%置信区间 = -6.58至5.03, = 0.79),存在高度异质性(I = 85%)。

有低质量证据表明,腕关节镜检查对DRF患者的功能结果无临床或统计学显著差异。然而,我们的研究结果受到纳入研究数量和缺乏长期随访的限制,尽管它们确实为未来的高质量研究提供了一个良好的起点。

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本文引用的文献

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History of Wrist Arthroscopy.腕关节镜检查史
J Wrist Surg. 2022 Apr 25;11(2):96-119. doi: 10.1055/s-0041-1740304. eCollection 2022 Apr.
2
Outcomes of Arthroscopic-Assisted Distal Radius Fracture Volar Plating: A Meta-Analysis.关节镜辅助下桡骨远端掌侧钢板内固定治疗桡骨远端骨折的疗效Meta 分析
J Hand Surg Am. 2022 Apr;47(4):330-340.e1. doi: 10.1016/j.jhsa.2021.11.025. Epub 2022 Feb 12.
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[Distal radius intraarticular fractures: fluoroscopy reduction versus arthroscopic assistance. Systematic review].[桡骨远端关节内骨折:透视下复位与关节镜辅助。系统评价]
Acta Ortop Mex. 2020 Nov-Dec;34(6):226-432.
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The PRISMA 2020 statement: an updated guideline for reporting systematic reviews.PRISMA 2020 声明:系统评价报告的更新指南。
BMJ. 2021 Mar 29;372:n71. doi: 10.1136/bmj.n71.
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What Is the Relative Effectiveness of the Various Surgical Treatment Options for Distal Radius Fractures? A Systematic Review and Network Meta-analysis of Randomized Controlled Trials.各种桡骨远端骨折手术治疗方法的相对有效性如何?一项随机对照试验的系统评价和网络荟萃分析。
Clin Orthop Relat Res. 2021 Feb 1;479(2):348-362. doi: 10.1097/CORR.0000000000001524.
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Volar Locked Plating Versus Closed Reduction and Casting for Acute, Displaced Distal Radial Fractures in the Elderly: A Systematic Review and Meta-Analysis of Randomized Controlled Trials.掌侧锁定钢板与闭合复位石膏固定治疗老年移位性桡骨远端骨折的随机对照试验的系统评价和 Meta 分析。
J Bone Joint Surg Am. 2020 Jul 15;102(14):1280-1288. doi: 10.2106/JBJS.19.01442.
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