切开复位内固定与外固定治疗不稳定桡骨远端骨折远期疗效的荟萃分析

Long-term efficacy of open reduction and internal fixation versus external fixation for unstable distal radius fractures： a meta-analysis

目的系统评价切开复位内固定与外固定两种方法治疗不稳定桡骨远端骨折的远期疗效。方法计算机检索PubMed，ScienceDirect，EMBASE，BIOSIS，Springer和Cochrane Library等数据库，纳入关于切开复位内固定与外固定两种方法治疗不稳定桡骨远端骨折远期疗效比较的随机对照试验（RCT）。制定入选和排除标准，筛选出符合纳入标准的文献，评价纳入研究的方法学质量。利用RevMan5．0（Cochrane Library）进行荟萃分析。结果共有16篇研究符合纳入标准，共1268例患者，切开复位内固定组618例，外固定组650例。切开复位内固定与外固定比较，在术后并发症[感染（I^2=0％，RR=0．27，95％CI0．16～0．45，Z=4．92，P〈0．00001）及术后总并发症（I^2=0％，RR=0．71，95％CI0．59—0．85，Z=3．65，P=0．0003）]、随访终期的DASH评分（I^2=37％，MD=-5．67，95％CI-8．31--3．04，Z=4．22，P〈0．0001）和掌倾角（I^2=78％，MD=2．29，95％CI0．33—4．24．Z=2．30，P=0．02）方面，两者差异有统计学意义（P〈0．05）；而随访终期的临床结果（握力、伸展、屈曲、旋前、旋后、桡偏及尺偏）及影像学结果（桡骨长度）方面，两者差异均无统计学意义（均P〉0．05）。结论切开复位内固定与外固定治疗不稳定桡骨远端骨折均取得了一定的远期疗效；与外固定相比，切开复位内固定具有更低的术后并发症、远期DSAH评分和更好的掌倾角恢复。

Objective To make a systematic assessment of the Long-term efficacy of open reduction and internal fixation versus external fixation for unstable distal radius fractures. Methods A computer-based online search of PubMed, ScienceDirect, EMBASE, B1OSIS, Springer and Cochrane Library were performed. The randomized and controlled trials of open reduction and internal fixation versus external fixation for unstable distal radius fractures were collected. The included trials were screened out strictly based on the criterion of inclusion and exclusion. The quality of included trials was evaluated. RevMan 5.0 was used for data analysis. Results Sixteen studies involving 1 268 patients were included. There were 618 patients with open reduction and internal fixation and 650 with external fixation. The results of meta-analysis indicated that there were statistically significant differences with regard to the complications postoperatively （ infection（ I2 = 0%, RR = 0. 27, 95% CI 0. 16 - 0. 45, Z = 4. 92, P 〈 0. 000 01 ） and total complications （I2=0%,RR=0.71, 95% CI0.59-0.85,Z=3.65,P=0.000 3） ）, DASH scores（l2 =37%,MD= -5.67, 95% CI -8.31 - -3.04,Z =4. 22,P 〈0. 000 1） and volar tih（Iz =78% ,MD =2.29, 95% CI 0. 33 - 4. 24, Z = 2. 30, P = 0. 02 ） （ P 〈 0. 05 ） at the end of follow-up period were noted. There were no statistically significant differences observed between two approaches with respect to the clinical outcomes （ grip strength, flexion, extension, pronation, supination, radial deviation and ulnar deviation ） and radiographic outcome（radial length） at the end of follow-up period （ P 〈 0. 05 ）. Conclusion Both open reduction and internal fixation and external fixation are effective treatment for unstable distal radius fractures. Compared with external fixation, open reduction and internal fixation provides reduced complications postoperatively, lower DASH scores and better restoration of valar tilt for treatment of distal radius fractures.