Tariq Muhammad A, Ali Uzair, Uddin Qazi S, Altaf Zahabia, Mohiuddin Ashar
Department of Surgery, Dow University Hospital, Dow University of Health Sciences, Karachi, Pakistan.
Department of Surgery, Dow Medical College, Dow University of Health Sciences Karachi, Pakistan.
J Wrist Surg. 2023 Apr 14;13(5):469-480. doi: 10.1055/s-0043-1768235. eCollection 2024 Oct.
This study aims to compare the outcomes of volar locking plating (VLP) versus percutaneous Kirschner wires (K-wire) fixation for surgical management of unstable distal radius fractures. We systematically searched multiple databases, including MEDLINE, EMBASE, Cochrane Central till January 2022 for randomized controlled trials (RCTs) that met eligibility criteria. Following outcomes were evaluated at 6-week, 3-, 6-, and 12-month follow-up period: Disabilities of the Arm, Shoulder, and Hand (DASH) score, Patient Rated Wrist Evaluation (PRWE) score, grip strength, range of motion, and complication incidence. Meta-analysis was performed using random effects models and results presented as risk ratios (RRs) or mean differences (MDs) with 95% confidence interval. Fourteen RCTs with 1,450 participants met the inclusion criteria. DASH scores were significantly better for VLP fixation at 6th week (MD = 19.02; < 0.001), 3rd (MD = 10.79; < 0.001), 6th (MD= 7.78; < 0.001), and 12th month (MD = 2.94; < 0.001) postoperation. At 3-month follow-up period, VLP treatment exhibited better grip strength (MD = - 10.32; < 0.001) and PRWE scores (MD = 8.78; < 0.001). There was a statistically significant early advantage in flexion, extension, pronation, supination, radial deviation, and ulnar deviation in the VLP group at 6-week follow-up, but at 1-year follow-up only significantly better extension was observed. At 1 year, radiographic outcomes were similar except for volar tilt favoring VLP fixation ( < 0.001). Superficial infections were more common in patients treated with K-wire (RR = 2.89; = 0.001), but there was no difference in total complications or reoperation rates ( > 0.05). This meta-analysis suggests that VLP fixation and K-wire fixation are both effective procedures, but existing literature does not provide sufficient evidence to demonstrate the superiority of either method. Although VLP fixation improves DASH score, extension and volar tilt at 12-month follow-up, the difference is small and unlikely to be noticeable to the patients.
本研究旨在比较掌侧锁定钢板（VLP）与经皮克氏针（K 线）固定治疗不稳定型桡骨远端骨折的手术效果。我们系统检索了多个数据库，包括 MEDLINE、EMBASE、Cochrane 中心，直至 2022 年 1 月，以查找符合纳入标准的随机对照试验（RCT）。在术后 6 周、3 个月、6 个月和 12 个月的随访期评估以下结果：上肢、肩部和手部功能障碍（DASH）评分、患者自评腕关节评估（PRWE）评分、握力、活动范围和并发症发生率。使用随机效应模型进行荟萃分析，并将结果表示为风险比（RRs）或平均差（MDs）以及 95%置信区间。14 项包含 1450 名参与者的 RCT 符合纳入标准。在术后第 6 周（MD = 19.02；P < 0.001）、第 3 个月（MD = 10.79；P < 0.001）、第 6 个月（MD = 7.78；P < 0.001）和第 12 个月（MD = 2.94；P < 0.001）时，VLP 固定的 DASH 评分显著更好。在 3 个月随访期，VLP 治疗的握力（MD = -10.32；P < 0.001）和 PRWE 评分（MD = 8.78；P < 0.001）更好。在 6 周随访时，VLP 组在屈曲、伸展、旋前、旋后、桡偏和尺偏方面具有统计学上显著的早期优势，但在 1 年随访时仅观察到伸展明显更好。在 1 年时，除了掌侧倾斜更有利于 VLP 固定外（P < 0.001），影像学结果相似。K 线治疗的患者浅表感染更常见（RR = 2.89；P = 0.001），但在总并发症或再次手术率方面没有差异（P > 0.05）。这项荟萃分析表明，VLP 固定和 K 线固定都是有效的治疗方法，但现有文献没有提供足够的证据证明哪种方法更具优势。尽管 VLP 固定在 12 个月随访时改善了 DASH 评分、伸展和掌侧倾斜，但差异很小，患者可能难以察觉。
