钢板内固定与小夹板治疗桡骨远端关节内骨折的效果比较

Plate fixation and small splint for intraarticular fracture of distal radius: comparison of curative effects

背景:目前,国内外有不少有关钢板内固定与小夹板治疗桡骨远端骨折的临床试验,但尚缺乏相关的系统评价。目的:评价钢板内固定与小夹板治疗桡骨远端关节内骨折疗效。方法:电子检索中国生物医学文献数据库(1979年至2008年)、中国知网(1979年至2008年)、维普数据库(1989年至2008年)和万方数字化期刊群(1998年至2008年),其中中国知网包括中国期刊文献数据库、重要会议全文数据库、硕博学位论文数据库;国外数据库PubMed(1966年至2008年)、EMbase(1980年至2008年)和Cochrane Library(2008年第4期)。不能获取的全文,则辅以手工检索天津中医药大学图书馆过刊资料库。收集钢板内固定与小夹板治疗桡骨远端关节内骨折的临床随机对照试验,由两名评价者独立提取资料并进行方法学质量评估。按检索策略和资料收集方法,查到英文文献363篇,中文文献488篇,其中期刊文献401篇,会议论文集79篇,学位论文8篇。经阅读标题、摘要、全文后,最终12项研究符合纳入标准。统计学采用Cochrane协作网提供的RevMan 5.0.20软件进行Meta分析。结果与结论:文章系统评价涉及锁定加压钢板、普通钢板内固定、小夹板及石膏外固定等方法。Meta分析结果显示,锁定加压钢板治疗桡骨远端关节内骨折的疗效优于普通钢板、小夹板或石膏外固定,且并发症少。而普通钢板内固定治疗桡骨远端关节内骨折的疗效与石膏外固定或小夹板比较疗效差异尚无显著性意义。

BACKGROUND： At present, there are many clinical trials concerning plate fixation and small splint for distal radius fracture, but there is lack of systemic evaluation. OBJECTIVE： To evaluate the curative effect of the plate fixation and small splint in the treatment of intraarticular fractures of the distal radius. METHODS： We retrieved the Chinese biomedical database （1979-2008）, China National Knowledge Infrastructure （1979-2008）, VIP database （1989-2008） and Wanfang Digital Periodical Group （1998-2008）. Of them, China National Knowledge Infrastructure contained Chinese periodical databases, important meeting full-text databases, and Master-Doctor thesis database. Foreign databases included PubMed （1966-2008）, EMbase （1980-2008） and the Cochrane Library （2008, 4th）. The full text that could access was supplemented by manual search back issues of Traditional Chinese Medicine, Tianjin University Library repository. Clinical randomized controlled trials addressing plate fixation with small splint in the treatment of intraarticular distal radius fractures were collected. The data were extracted independent by two evaluators and methodological quality assessment was performed. According to the search strategy and data collection methods, 363 English articles and 488 Chinese articles were found, including 401 periodical literatures, 79 conference proceedings, and 8 theses. After reading title, abstract, full text, 12 articles met the inclusion criteria. Meta analysis was conducted with RevMan 5.0.20 software provided by the Cochrane Collaboration Network. RESULTS AND CONCLUSION： The evaluation of this system involves locking compression plate, normal internal fixation with plate, small splints and plaster external fixation methods. Meta analysis of the results shows that the curative effects of locking compression plate in the treatment of intraarticular fracture of distal radius were better than that of common plate, small splint or gypsum. Moreover, there were few complications. There is no significant difference in the effects between common plate fixation in treatment of intraarticular fracture of distal radius and the fixation with small splint or gypsum.