夹板与石膏管型外固定物治疗儿童前臂远端隆突样骨折的系统评价

Splint versus plaster cast external fixator for the treatment of distal forearm buckle fracture in children: systematic review

背景:儿童前臂远端隆突样骨折一般无继发移位风险,文献报道可通过石膏管型、掌侧托、夹板、支具以及绷带等外固定物治疗获得满意疗效。但是不同外固定物治疗对患儿功能恢复及生活能力的影响并不明确。目的:评价夹板与石膏管型外固定物治疗儿童前臂远端隆突样骨折的疗效和安全性。方法:计算机检索Medline、Embase、Cochrane图书馆(2011年第3期)及中国生物医学数据库、中国期刊全文数据库,检索时限为建库至2011年4月;手工检索相关会议论文;在线检索重要临床试验注册中心,文献检索无语种限制。收集随机对照及半随机对照试验,行质量评价并采用Revman 5.1行Meta分析。结果与结论:纳入2项研究,包括314例患者,1项随机对照试验评价为B级,1项半随机对照试验评价为C级。结果表明,夹板与石膏管型外固定物治疗后均无骨折、骨折不愈合以及再骨折,患肢疼痛以及书写、绘画、自理饮食、洗漱4方面生活能力差异无显著性意义;而固定后患儿洗澡能力夹板组早期优于石膏管型组,后期差异无显著性意义。参加规律运动方面亦为夹板固定组优于石膏管型固定组。两种固定方法不良事件发生率比较差异无显著性意义。提示夹板与石膏管型外固定物治疗儿童前臂远端隆突样骨折后患肢疼痛无明显改善,但夹板固定有利于维持洗澡能力及参加规律运动,且安全性良好。但仍需设计良好、实施完善的大样本、多中心随机对照试验验证。

BACKGROUND：The distal forearm buckle fracture in children has no secondary displacement risk, and the literatures have reported that the fracture can be treated with external fixators of plaster cast, palm side plate, splint, brace and bandage, and obtain good effect. But different external fixators have different effects on the functional recovery and viability. OBJECTIVE：To assess the clinical efficacy and safety of splint versus plaster cast for the treatment of distal forearm buckle fracture in Children. METHODS： The Medline database, Embase database, Cochrane Library, CNKI database and CBM database were searched from the database establishment to April 2011 with the computer;the relative conference papers were hand searched;the Important Clinical Trial Register was searched online without limitation of language.＆nbsp;Randomized control ed trials and quasi-randomized control trials were selected for quality evaluation, and the Meta-analysis was performed with Revman 5.1. RESULTS AND CONCLUSION：Two published trials including a total of 314 patients were included, and one randomized control ed trial was evaluated as B scale, another one quasi-randomized control trial was evaluated as C scale. The results demonstrate that no fracture, un-union or re-fracture occurred after treated with splint and plaster case external fixator, and there were no significant differences in pain scores as wel as the daily activities of writing, drawing, self-eating and washing;while the early bathing ability of the patients in the splint group was earlier than that in the plaster cast group, and had no significant difference in the advanced bathing ability. The regular exercise participation in the splint group was better than that in the plaster cast group. There were no significant differences in the incidence of adverse events between two groups. The results indicate that the pain score of the patients with distal forearm buckle fracture in children do not improved after treated with splint and plaster cast, but splint fixation is better than plaster cast fixation in maintaining the batching and regular exercise participation ability with good safety. But the wel-designed and implement large sample and multi-center randomized control ed trials are needed for validation.