钢板与外固定架固定治疗AO-C型桡骨远端骨折疗效的Meta分析  

Meta-analysis of the efficacy of plate fixation and external fixator fixation in the treatment of AO-C type distal radius fractures

作　　者：李光耀 成永忠[2,3] 刘峘 姜俊杰[4] 李永耀[2] 陈洋[2] 姚宇翔 LI Guang-yao;CHENG Yong-zhong;LIU Huan;JIANG Jun-jie;LI Yong-yao;CHEN Yang;YAO Yu-xiang(Beijing University of Chinese Medicine,Beijing100029,China;Department of Traumatology,Wangjing Hospital,China Academy of Chinese Medical Sciences,Beijing100102,China;Nanyang Hospital of Traditional Chinese Medicine,Nanyang473007,Henan,China;Institute of Basic Research in Clinical Medicine,China Academy of Chinese Medical Sciences,Beijing100700,China;Unit 66322 of the People's Liberation Army,Beijing100000,China)

机构地区：[1]北京中医药大学,北京100029 [2]中国中医科学院望京医院创伤一科,北京100102 [3]南阳市中医院,河南南阳473007 [4]中国中医科学院中医临床基础医学研究所,北京100700 [5]中国人民解放军66322部队,北京100000

出　　处：《中国骨伤》2025年第1期66-80,共15页China Journal of Orthopaedics and Traumatology

基　　金：北京市科学技术委员会-首都临床特色诊疗技术研究及转化应用(编号:Z221100007422075);中国中医科学院科技创新工程-重大攻关项目(编号:CI2021A02008)。

摘　　要：目的:Meta分析钢板与外固定架固定治疗AO-C型桡骨远端骨折的临床疗效。方法:检索PubMed、Embase、Cochrane Library、Web of Science、中国知网、万方、维普和SinoMed数据库所有关于AO-C型桡骨远端骨折的随机对照临床试验的文献,检索时限均从各数据库建库到2023年6月30日。纳入研究参照Cochrane手册(Version6.3,2022)进行信息提取、文献质量评价,采用RevMan 5.4软件进行发表偏倚风险评价、检验异质性并进行Meta分析。结局指标为:影像学解剖指标(掌倾角、尺偏角、桡骨高度)、腕关节活动度(屈伸、旋转、尺桡偏)、并发症发生率、手术治疗情况比较(手术出血量、手术时间、住院时间、骨折愈合时间)和腕关节功能评分及相关量表。结果:(1)共纳入28项研究,患者共计2192例,包括1096例钢板内固定组和1096例外固定架组。(2)Meta分析结果显示:外固定架组的手术出血量[MD=-37.93,95%CI(-48.54,-27.31),P<0.00001]、手术时间[MD=-31.58,95%CI(-48.96,-14.20),P=0.0004]、住院时间[MD=-4.58,95%CI(-5.44,-3.71),P<0.00001]、骨折愈合时间[MD=-0.88,95%CI(-1.35,-0.41),P=0.0002]均显著优于钢板内固定组(P<0.05)。(3)两组的掌倾角[MD=-0.17,95%CI(-0.95,0.61),P=0.68]、尺偏角[MD=0.22,95%CI(-0.73,1.17),P=0.65]、桡骨高度[MD=-0.24,95%CI(-1.15,0.67),P=0.60],屈伸[MD=-5.63,95%CI(-11.85,0.58),P=0.08]、旋转[MD=-5.80,95%CI(-12.77,1.17),P=0.10]、尺桡偏[MD=-2.86,95%CI(-10.87,5.15),P=0.48],并发症发生率[RR=0.96,95%CI(0.63,1.46),P=0.83],Gartland-Werley腕部临床评分[MD=0.13,95%CI(-0.80,1.06),P=0.78]、Gartland-Werley腕部临床评分优良率[RR=0.93,95%CI(0.87,1.01),P=0.08]、Cooney腕关节评分优良率[RR=0.99,95%CI(0.62,1.59),P=0.98]、腕关节DASH评分[MD=-4.67,95%CI(-14.96,5.62),P=0.37]的差异均无统计学意义(P>0.05)。结论:与钢板内固定相比,外固定架治疗AO-C型桡骨远端骨折可以显著减少手术出血量、缩短手术时间与住院时间和骨折愈合时间,�Objective Meta-analysis of the clinical efficacy of plate and external fixator fixation in the treatment of AO-C type distal radius fractures.Methods PubMed,Embase,Cochrane Medical Library,Web of Science,CNKI,Wanfang,VIP and SinoMed databases were searched for all literature on randomized controlled clinical trials of AO-C distal radius fractures.The search time limits were from each database.The database will be established until June 30,2023.The included studies were extracted according to the Cochrane Handbook(Version 6.3,2022)for information extraction and literature quality evaluation.RevMan 5.4 was used to evaluate the risk of Publication bias,test heterogeneity and Perform Meta-analysis.The outcome indicators were:imaging anatomy indicators(volar inclination angle,ulnar deviation angle,radial height),wrist joint mobility(flexion,extension,rotation,ulnar deviation),complication rate,and comparison of surgical treatments(operative blood loss,operation time,hospitalization time,fracture healing time)and wrist joint function scores and related scales.Results(1)A total of 28 studies were included,with a total of 2192 patients,including 1096 cases in the plate internal fixation group and 1096 cases in the external fixation group.(2)Meta analysis results showed:the surgical treatment situation of the external fixation group:surgical blood loss MD=-37.93,95%CI(-48.54,-27.31),P<0.00001;operation time MD=-31.58,95%CI(-48.96,-14.20),P<0.0004;hospitalization time MD=-4.58,95%CI(-5.44,-3.71),P<0.00001;the fracture healing time MD=-0.88,95%CI(-1.35,-0.41),P<0.0002,which were significantly better than that of the plate internal fixation group(P<0.05).(3)The two groups:palmar inclination angle MD=-0.17,95%CI(-0.95,0.61),P=0.68;ulnar declination MD=0.22,95%CI(-0.73,1.17),P=0.65,radial height MD=-0.24,95%CI(-1.15,0.67),P=0.60;flexion and extension MD=-5.63,95%CI(-11.85,0.58),P=0.08;rotation MD=-5.80,95%CI(-12.77,1.17),P=0.10,radioulnar deviation MD=-2.86,95%CI(-10.87,5.15),P=0.48;complication rate RR=0.96,95%CI(0.63,1.46),P

关 键 词：钢板内固定 外固定架 AO-C型桡骨远端骨折 META分析 

分 类 号：R683.41[医药卫生—骨科学]