手法复位小夹板固定治疗老年桡骨远端骨折临床疗效Meta分析

Evidence of Small Splint External Fixation after Manual Reduction for Senile Distal Radius Fractures:A Meta-analysis

目的系统评价手法复位小夹板固定治疗老年人桡骨远端骨折的临床疗效和安全性。方法检索知网、万方、维普、中国生物医学文献、Pubmed、Embase、Cochrane Library数据库(1990.1—2017.3)中有关手法复位小夹板固定治疗老年人桡骨远端骨折的随机对照试验。以关节功能恢复优良率、骨折愈合时间、并发症作为结局指标。原始研究质量评估采用Cochrane风险偏移评估工具,并使用Revman 5.3软件进行Meta分析。结果共10项研究850例患者,研究质量均存在高度偏倚风险。Meta分析发现:与石膏相比,小夹板可以显著提高Gartland-Werley评分[OR=2.25,95%CI(1.34,4.90),P<0.01],并减少并发症的发生[OR=0.29,95%CI(0.11,0.75),P<0.01]。与切开内固定或者外固定支架比较,小夹板可以明显缩短骨折愈合时间[SMD=-0.87,95%CI(-1.10,-0.64),P<0.01]和[SMD=-1.04,95%CI(-1.39,-0.68),P<0.01]。结论手法复位小夹板外固定技术有利于缩短老年人桡骨远端骨折愈合时间,提高关节功能活动。

Objective To evaluate the effectiveness and safety of small splint external fixation for distal radius fractures in the senile based on meta-analysis. Methods This review retrieved PubMed,EMBASE,Cochrane Library, CNKI, VIP, Wanfang Data and Chinese Biomedical Literature Database(1990.1-2017.3) using computer. Randomised controlled trials investigating treatment of distal radius fractures in the elderly for which small splint external fixation was used as a monotherapy compared to other conventional therapy were collected. Besides,the outcomes included the evaluation of functional activities,the healing time of fracture and complications.The risk of bias was evaluated by the Cochrane Collaboration tool and the data was statistically analyzed by RevMan 5.3 software. Results Ten studies with 850 participants were identified.The quality presented a high risk of bias. Meta-analysis results displayed that small splint external fixation had a more significant effect in improving the Gartland-Werley scores[OR=2.25,95%CI(1.34, 4.90), P<0.01]and in reducing the incidence of complications[OR=0.29,95%CI(0.11, 0.75), P<0.01],compared with plaster cast. Meanwhile,it had a more significant effect in shorting the healing time of fracture([SMD=-0.87,95%CI(-1.10,-0.64), P<0.01]and[SMD=-1.04,95%CI(-1.39,-0.68), P<0.01]),respectively compared with open reduction internal fixation or outside fixed support. Conclusions Small splint external fixation after manual reduction appears to have benefits for shorting the healing time and improving the functional activities of the senile with distal radius fractures.