支架外固定与钢板内固定治疗桡骨远端粉碎性骨折的Meta分析  

Meta-analysis of external stent fixation and internal plate fixation for treatment of comminuted distal radius fractures

作　　者：林晴 刘峘[2] 成永忠[3] 姜俊杰[2] 李永耀[3] 李光耀 Lin Qing;Liu Huan;Cheng Yongzhong;Jiang Junjie;Li Yongyao;Li Guangyao(Beijing University of Chinese Medicine,Beijing 100020,China;Institute of Clinical Basic Medicine,China Academy of Chinese Medical Sciences,Beijing 100010,China;First Department of Trauma,Wangjing Hospital,China Academy of Chinese Medical Sciences,Beijing 100020,China)

机构地区：[1]北京中医药大学,北京市100020 [2]中国中医科学院中医临床基础医学研究所,北京市100010 [3]中国中医科学院望京医院创伤一科,北京市100020

出　　处：《中国组织工程研究》2025年第21期4602-4611,共10页Chinese Journal of Tissue Engineering Research

基　　金：首都临床特色诊疗技术研究及转化应用(Z221100007422075),项目负责人:成永忠;中国中医科学院望京医院自主选题专项课题(WJYY-ZZXT-2022-10),项目负责人:成永忠;中国中医科学院科技创新工程重点项目(CI2021A02008),项目负责人:成永忠。

摘　　要：目的:外固定支架和钢板内固定作为桡骨远端粉碎性骨折的常用治疗方法,在临床上各有利弊。系统评价外固定支架与钢板内固定治疗粉碎性桡骨远端骨折的临床疗效及安全性,为桡骨远端骨折中西医结合诊疗指南研制提供论证依据。方法:系统检索PubMed、Web of Science、Embase、Cochrane Library、中国知网、中国生物医学文献数据库、维普和万方数据库,纳入2013年10月至2023年10月发表的关于外固定支架和钢板内固定治疗粉碎性桡骨远端骨折的随机对照试验文献,按照纳入标准和排除标准筛选文献,使用Review Manager进行文献质量评价和Meta分析。结果:(1)纳入8篇文献,其中中文文献4篇,英文文献4篇、总样本量648例,外固定支架组328例,钢板内固定组320例;(2)术后3个月,钢板内固定组的背伸、掌屈、旋后范围优于外固定支架组;术后12个月,钢板内固定组的握力、掌倾角、掌屈、旋前和旋后范围优于外固定支架组;钢板内固定组在术后感染方面优于外固定支架组,其余结局指标两组差异均无显著性意义。结论:现有8项证据表明,在粉碎性桡骨远端骨折的治疗方式选择上,外固定支架与切开钢板内固定都有良好的治疗效果,综合其他因素钢板内固定更胜一筹,但是对于一些高度严重的粉碎性桡骨远端骨折、骨质较差、严重污染的开放性骨折以及软组织肿胀而无法进行切开手术的特殊患者,外固定支架才是首选。此次研究结果具有局限性,未来还需要开展更多高质量、大样本、多中心的随机对照试验研究,另外需重视远期疗效、其他次要指标的观察,补充优化当前研究结果。OBJECTIVE:External fixators and plate internal fixation are commonly used treatments for comminuted distal radius fractures,each with its own advantages and disadvantages in clinical practice.To systematically evaluate the clinical efficacy and safety of external fixator and plate internal fixation in the treatment of comminuted distal radius fractures,and to provide a basis for the development of guidelines for the diagnosis and treatment of distal radius fractures with integrated traditional Chinese and Western medicine.METHODS:PubMed,Web of Science,Embase,Cochrane Library,China National Knowledge Infrastructure,China Biomedical Literature Database,VIP,and WanFang databases were systematically searched to include randomized controlled trials on external fixators and internal plate fixation for the treatment of comminuted distal radial fractures published from October 2013 to October 2023.The literature was screened according to the inclusion and exclusion criteria.Review Manager was used for literature quality evaluation and meta-analysis.RESULTS:(1)Eight articles were included,including 4 in Chinese and 4 in English,with a total sample size of 648 cases,including 328 cases in the external fixation stent group and 320 cases in the internal fixation plate group.(2)At 3 months after operation,the internal fixation plate group was superior to the external fixation stent group in the range of dorsal extension,palmar flexion and supination.At 12 months after operation,the grip strength,palmar inclination,palmar flexion,pronation and supination in the internal fixation plate group were better than those in the external fixation stent group.The postoperative infection in the internal fixation plate group was better than that in the external fixation stent group,and there was no statistical difference in other outcome indicators.CONCLUSION:Eight evidences showed that in the choice of treatment for comminuted distal radius fracture,both external fixation stent and incision plate internal fixation had good therapeutic ef

关 键 词：粉碎性桡骨远端骨折 外固定支架 内固定 临床疗效 安全性 荟萃分析 

分 类 号：R459.9[医药卫生—治疗学] R318[医药卫生—临床医学] R683.4