中药熏洗对指骨骨折微型钢板内固定术后临床疗效的Meta分析

Meta analysis of the clinical efficacy of herbal fumigating and washing on phalangeal fractures with mini plate internal fixation

目的:系统评价中药熏洗对指骨骨折微型钢板内固定术后的临床疗效。方法:计算机检索Cochrane Library、PubMed、Embase、中国知网、中国生物医学文献数据库、维普数据库和万方数据库中关于指骨骨折微型钢板内固定术后使用中药熏洗治疗的随机对照试验(Randomized Controlled Trial,RCT),各数据库检索时间范围均限定为建库至2019年12月,筛选出符合纳入标准的文献,对纳入文献采用Cochrane偏倚风险评价工具进行质量评价和数据提取,使用Review Manager 5.3软件进行Meta分析。结果:共纳入8项RCT,933例患者,治疗组468例,对照组465例进行Meta分析;指骨骨折微型钢板内固定术后使用中药熏洗能够缩短骨折愈合时间(MD=-15.02;(95%CI[-24.19,-5.86];Z=3.21,P=0.001);提升优良率(OR=3.46;95%CI[2.25,5.33];Z=5.63,P<0.00001);减少并发症发生率(OR=0.42;95%CI[0.23,0.75];Z=2.94,P=0.003);缩短住院时间(MD=-0.61;95%CI[-1.05,-0.17];Z=2.70;P=0.007);提升掌指关节主动活动度与生活质量评分。结论:中药熏洗能够有效缩短指骨骨折微型钢板内固定术后骨折愈合时间,提升优良率,减少并发症的发生,提高治疗效果。但以上结果仍需开展严谨的高质量、大样本随机对照试验,进一步完善安全性评价加以论证。

Objective:To systematically evaluate the clinical efficacy of herbal fumigation and washing on phalangeal fractures after mini plate internal fixation.Methods:Computer retrieval of RCT of the treatment of phalangeal fractures with fumigation and washing after micro plate internal fixation was performed in Cochrane Library,PubMed,Embase,CNKI,CBM,VIP and Wanfang database,the retrieval time range of each database was limited to the period from the establishment of the database to December 2019.The documents meeting the inclusion criteria were screened out.The included documents were evaluated and extracted by Cochrane bias risk assessment tool,and Meta analysis is carried out by Review Manager 5.3 software.Results:A total of 8 RCTs involving 933 patients,468 patients in the treatment group and 465 patients in the control group were included in the Meta-analysis.The results showed that the use of fumigating and washing with Chinese herbs after the internal fixation of phalangeal fractures with mini plate could shorten the time of fracture healing(MD=-15.02;(95%CI[-24.19,-5.86];Z=3.21,P=0.001);improve the excellent rate(OR=3.46;95%CI[2.25,5.33];Z=5.63,P<0.00001);reduce the incidence of complications(OR=0.42;95%CI[0.23,0.75];Z=2.94,P=0.003),shorten the hospitalization time(MD=-0.61;95%CI[-1.05,-0.17];Z=2.70;P=0.007),improve the active activity of metacarpophalangeal joint and quality of life.Conclusion:Fumigating and washing with traditional Chinese medicine can effectively shorten the hospitalization time and fracture healing time after internal fixation with mini plate for phalangeal fracture,improve the excellent rate,reduce the occurrence of complications and improve the treatment effect.However,it is still necessary to carry out rigorous high-quality,large sample randomized controlled trials to further improve the safety evaluation.