Latypov Niyaz, Golubev Igor, Borisova Alyona
Federal State Budgetary Institution of the Ministry of Health of the Russian Federation National Medical Research Center of Traumatology and Orthopedics named after N.N. Priorov, Moscow, Russian Federation.
"Private clinic Almaty", Almaty, Kazakhstan.
J Wrist Surg. 2023 Nov 7;13(6):559-571. doi: 10.1055/s-0043-1774331. eCollection 2024 Dec.
A systematic review and meta-analysis of randomized controlled trials was conducted to compare surgical treatment using open reduction and internal fixation (ORIF) with volar locking plates (VLP) to conservative treatment with closed reduction and immobilization in elderly patients aged ≥60 years with acute displaced distal radius fractures. A search of the MEDLINE, Scopus, and Central Register of Controlled Trials (CENTRAL) databases was conducted. Clinical and radiographic measures at 12 months were compared between groups by pooling the mean difference. The complication rates were compared by pooling relative risk ratios. Pooled mean differences of Disabilities of the Arm, Shoulder, and Hand (DASH) and Patient-Rated Wrist Evaluation (PRWE) results were compared with the published minimal clinically important difference (MCID) to evaluate the clinical relevance of the results. The initial search yielded 766 records, from which 6 articles were selected for the final analysis. The results of the DASH questionnaire at 12 months of follow-up were significantly lower in the surgical treatment group with a mean difference (MD) of -3.61 points (95% confidence interval [CI]: -6.48 to -0.73). No statistically significant difference was found in the PRWE questionnaire (MD = -3.14 points [95% CI: -7.32 to 1.04]). Radiological results were significantly better in the surgical treatment group and no significant difference in the overall complication rate between the groups was detected. Found MD for DASH and PRWE did not reach the published MCIDs. This study suggests that for elderly patients aged ≥60 years with acute displaced distal radius fractures, surgical treatment using ORIF with VLP does not provide clinically relevant benefits compared with conservative treatment with closed reduction and immobilization at the 12-month follow-up, despite demonstrating better radiological results.
我们进行了一项随机对照试验的系统评价和荟萃分析，以比较采用切开复位内固定术（ORIF）结合掌侧锁定钢板（VLP）的手术治疗与闭合复位及固定的保守治疗，用于年龄≥60岁的急性桡骨远端移位骨折老年患者。
对MEDLINE、Scopus和对照试验中央注册库（CENTRAL）数据库进行了检索。通过汇总平均差来比较两组在12个月时的临床和影像学指标。通过汇总相对风险比来比较并发症发生率。将手臂、肩部和手部功能障碍（DASH）及患者自评腕关节评估（PRWE）结果的汇总平均差与已发表的最小临床重要差异（MCID）进行比较，以评估结果的临床相关性。
初步检索得到766条记录，从中筛选出6篇文章进行最终分析。在随访12个月时，手术治疗组的DASH问卷结果显著更低，平均差（MD）为-3.61分（95%置信区间[CI]：-6.48至-0.73）。PRWE问卷未发现统计学显著差异（MD = -3.14分[95% CI：-7.32至1.04]）。手术治疗组的影像学结果显著更好，且两组之间的总体并发症发生率未发现显著差异。发现DASH和PRWE的MD未达到已发表的MCID。
本研究表明，对于年龄≥60岁的急性桡骨远端移位骨折老年患者，在12个月的随访中，与采用闭合复位及固定的保守治疗相比，采用ORIF结合VLP的手术治疗未提供具有临床相关性的益处，尽管影像学结果更好。
