掌侧钢板内固定与闭合复位外固定治疗成人桡骨远端骨折疗效的Meta分析

Meta-analysis of the efficacy of volar plate internal fixation versus closed reduction and external fixation in the treatment of adult distal radius fractures

目的:应用Meta分析的方法比较切开复位掌侧锁定钢板内固定与闭合复位外固定治疗桡骨远端骨折的疗效差异。方法:检索中国知网、万方、维普、中国生物医学文献、Pubmed、Embase、Cochrane Library数据库,收集自建库以来至2023年4月公开发表的直接比较钢板内固定与闭合复位外固定治疗桡骨远端骨折疗效差异的随机对照研究。2名研究者根据纳入及排除标准对检索文献进行独立筛选,提取数据并采用Cochrane风险偏倚评估工具进行质量评估,并使用RevMan 5.4软件进行Meta分析。结果:共纳入10篇随机对照试验研究,均为英文文献,共计1042例患者,其中9篇文献质量评为低风险。Meta分析结果显示,掌侧锁定钢板内固定治疗桡骨远端骨折在1年后DASH评分[MD=−5.64,95%CI(−7.21,−4.06),P<0.00001];1年后PRWE评分[MD=−5.90,95%CI(−8.88,−2.92),P=0.001];掌屈[MD=5.92,95%CI(1.29,10.55),P=0.01];旋前[MD=2.48,95%CI(0.59,4.36),P=0.01];旋后[MD=4.73,95%CI(2.15,7.31),P=0.0003];握力[MD=0.61,95%CI(0.12,1.10),P=0.02];掌倾角[MD=9.84,95%CI(5.66,14.02),P<0.00001];尺偏角[MD=4.33,95%CI(2.97,5.69),P<0.00001]方面均优于闭合复位石膏或夹板外固定治疗。二者在1年后欧洲五维健康量表(EQ‑5D‑5L)评分[MD=0.02,95%CI(−0.01,0.05),P=0.27];背伸[MD=2.22,95%CI(−4.15,8.59),P=0.49];尺偏[MD=3.49,95%CI(−0.80,7.78),P=0.11];桡偏[MD=2.05,95%CI(−2.39,6.50),P=0.37];尺骨变异[MD=−1.14,95%CI(−3.16,0.88),P=0.27];并发症[MD=0.77,95%CI(0.54,1.10),P=0.16]方面差异均无统计学意义(P>0.05)。结论:基于当前临床数据,掌侧锁定钢板内固定较闭合复位石膏或夹板外固定治疗更有利于中期DASH评分和握力恢复,但患者的生活质量及并发症等无明显差异。对于成人桡骨远端骨折,应谨慎把握手术适应症,优先考虑非手术治疗。

Objective:To compare the efficacy of open reduction and volar locking plate internal fixation with closed reduc-tion and external fixation in the treatment of distal radius fractures by using meta analysis.Methods:The databases of CNKI,Wanfang,VIP,Chinese biomedical literature,PubMed,Embase,and Cochrane Library were retrieved,and the randomized con-trolled studies that directly compared the efficacy of plate internal fixation and closed reduction external fixation in the treatment of distal radius fractures published publicly from the establishment of the database to April 2023 were collected.The two researchers independently screened the retrieved literature according to the inclusion and exclusion criteria,extracted data,used Cochrane risk bias assessment tool for quality assessment,and used RevMan 5.4 software for meta analysis.Results:A total of 10 randomized controlled trials were included,all of which were in English.There were 1042 patients in total,and 9 of them were rated as low risk.Meta analysis results showed that one year after the treatment of distal radius fracture with volar locking plate internal fixa-tion,DASH score[MD=-5.64,95%CI(-7.21,-4.06),P<0.00001];One year later,PRWE score[MD=-5.90,95%CI(-8.88,-2.92),P=0.001];Palm flexion[MD=5.92,95%CI(1.29,10.55),P=0.01];Pronation[MD=2.48,95%CI(0.59,4.36),P=0.01];Postrotation[MD=4.73,95%CI(2.15,7.31),P=0.0003];Grip strength[MD=0.61,95%CI(0.12,1.10),P=0.02];Palmar tilt angle[MD=9.84,95%CI(5.66,14.02),P<0.00001];Radial inclination[MD=4.33,95%CI(2.97,5.69),P<0.00001]was superior to closed reduction plaster or splint external fixation.One year later,the European Five dimensional Health Scale(EQ-5D-5L)score[MD=0.02,95%CI(-0.01,0.05),P=0.27];Back extension[MD=2.22,95%CI(-4.15,8.59),P=0.49];Ulnar deviation[MD=3.49,95%CI(-0.80,7.78),P=0.11];Radial deviation[MD=2.05,95%CI(-2.39,6.50),P=0.37];Ulnar variance[MD=-1.14,95%CI(-3.16,0.88),P=0.27];There was no significant difference in complica-tions[MD=0.77,95%CI(0.54,1.10),P=0.16](P>0.05).Conclusion:Based on the current clinical data,internal fixation with volar locking plate is more conducive to mid-term DASH score and grip strength recovery than closed reduction plaster or splint ex-ternal fixation,but there is no significant difference in the quality of life and complications of patients.For adult distal radius frac-tures,surgical indications should be carefully grasped,and non operative treatment should be given priority.