桥式外固定和非桥式外固定治疗桡骨远端骨折的系统评价与Meta分析

Bridging versus non-bridging external fixations for fractures of the distal radius： a systematic review

目的 系统评价桥式外固定和非桥式外固定治疗桡骨远端骨折的疗效.方法 按Cochrane系统评价方法,计算机检索Cochrane图书馆、Cochrane协作网创伤数据库（2009年）、MED-LINE（1966年至2009年12月）、Embase（1966年至2009年）、中国生物医学文献数据库（1979年1月至2009年12月）、PubMed、万方数据库和维普数据库,手工检索中文骨科期刊的相关文献.收集桥式外固定和非桥式外固定治疗桡骨远端骨折的随机对照试验（RCT）和半RCT,评价纳入研究的方法学质量,提取有效数据进行Meta分析.结果 最终纳入5个RCT,共785例患者.桥式外固定组治疗后的针道感染率、神经损伤率低于非桥式外固定组,差异有统计学意义;其他并发症如腕管综合征发生率、畸形愈合率等差异无统计学意义.桥式外固定组与非桥式外固定组治疗桡骨远端骨折3个月和1年后的手腕部功能如背伸、旋前和旋后差异无统计学意义.结论 与非桥式外固定相比,桥式外固定治疗后的针道感染率和神经损伤率更低,是一种更好的选择.

Objective To determine the clinical effects of bridging versus non-bridging external fixations for fractures of the distal radius. Methods The Cochrane library, MEDLINE （1966-2009）,EMBASE （1966-2009）, CBM （1979-2009） and the relevant English and Chinese orthopedic journals were searched for the randomized controlled trials and controlled clinical trials of bridging versus non-bridging external fixations for treatment of fractures of the distal radius. The systematic review was performed using the method recommended by the Cochrane Collaboration. Results Five randomized trials were included,involving 785 patients. Meta-analysis showed no significant differences in postoperative functions, such as extension, supination and pronation, after 3 to 12 months between the 2 fixations. The rates of pin track infection and nerve injury in the bridging group were significantly lower than in the non-bridging group, but there were no significant differences in carpal tunnel syndrome, malunion and complex regional pain syndrome.Conclusion Bridging external fixation, which does not rely on a distal intact volar cortex of 1cm but can reduce the rates of pin track infection and nerve injury, may be a better alternative than non-bridging external fixation for fractures of the distal radius.