外固定支架与小夹板固定治疗桡骨远端不稳定性骨折的系统评价

External Fixation Support Versus Small Splint Fixation in Unstable Distal Radius Fractures:a Meta-analysis

目的通过Meta分析,对外固定支架与小夹板治疗桡骨远端不稳定性骨折的疗效进行系统评价。方法计算机检索Cochrane Library、MEDLINE、EMbase、CBM等数据库,手工检索与骨科相关的文献和会议论文。按照纳入标准,收集所有比较外固定支架与小夹板治疗桡骨远端不稳定性骨折的随机对照试验,采用Meta分析方法对腕关节功能、复位效果、并发症发生率进行分析。统计软件采用Cochrane协作网提供的RevMan5.1。结果纳入8篇随机对照试验,共713例患者。①外固定支架组腕关节功能优良率优于小夹板组[RR=1.25,P<0.01];②复位效果:外固定支架组治疗后复位优良率高于小夹板组[RR=1.24,P<0.01],而且治疗后6个月掌倾角[MD=4.85,P<0.01]、尺偏角[MD=3.63,P<0.01]大于小夹板组,而桡骨轴向短缩长度[MD=-3.42,P<0.01)]小于小夹板组;③外固定支架组的并发症较小夹板组少[RR=0.62,P<0.01]。结论外固定支架治疗桡骨远端不稳定性骨折优于小夹板固定。但由于现有研究存在的方法学不完善和样本的局限性,上述结论有待设计更严谨的大样本随机对照试验加以验证。

OBJECTIVE Through meta analysis to compare the effect of external fixation support versus small splint fixa- tion in unstable distal radius fractures regarding clinical results, radiological outcomes and postoperative complications. METH- ODS Cochrane Library, MEDLINE, EMbase, CBM and the relevant English and Chinese orthopedic journals were searched for the randomized controlled trials of external fixation support versus small splint fixation in unstable distal radius fractures. Then the researchers analyzed wrist functions, radiological outcomes and complications though meta analysis. RESULTS A total of 8 RCTs with a total of 713 participants were included. The results of Meta-analyses showed that compared with small splint fixation fixation, wrist functions[-RR=l. 25, P〈0.01] and radiological outcomes[RR= 1.24, P%0.01] were superior in the external fixation support group, meanwhile, the loss of volar tilt angle[MD：4.85, P%0.01] and ulnar inclination angle [-MD= 3.20, P%0.01] were smaller and the length of radial shortening [MD= = 3. 42, P%0.01] was shorter after six months follow-up. And external fixation support fixation led to significantly fewer total complications[RR= 0.62, P%0.01]. CONCLUSION External fixation support is a better alternative to small splint fixation for unstable distal radius fractures. However, more high quality, large scale and multicentric randomized controlled trials are required for more accurate conclu- sion.