外固定架与钢板内固定治疗桡骨远端骨折Meta分析  

Meta-analysis of external fixator and plating internal fixation for distal radius fracture

作　　者：张玉衡 赵月纯 成永忠[1] 桑志成[1] ZHANG Yu-heng;ZHAO Yue-chun;CHENG Yong-zhong;SANG Zhi-cheng(Department of Bone and Joint,Wangjing Hospital,China Academy of Chinese Medicine Sciences,Beijing 100029,China;Graduate School of Beijing University of Chinese Medicine,Beijing 100029,China)

机构地区：[1]中国中医科学院望京医院骨科,北京100102 [2]北京中医药大学研究生院,北京100029

出　　处：《河北医科大学学报》2025年第2期137-147,共11页Journal of Hebei Medical University

基　　金：中国中医科学院望京医院自主选题专项课题(WJYY-ZZXT-2022);中国中医科学院创新工程项目资助(CI2021A02008)。

摘　　要：目的采用系统评价,探明闭合复位后外固定架固定与切开复位后钢板内固定在治疗桡骨远端骨折(distal radius fracture,DRF)时的疗效优劣。方法检索公开数据库,如Pubmed、中国知网、万方等,收集自建库至2023年7月以来公开发表的关于这两种方法的随机对照试验(randomized controlled trail,RCT)。人工对检索文献进行筛选,对于最终纳入的研究,使用Cochrane风险偏倚评估工具进行质量与偏倚风险评估,采用RevMan 5.4软件进行Meta分析,比较两种方法术后影像学、功能评分以及并发症等方面的优劣。结果共纳入20篇RCT文献,共计1845例患者,其中外固定架组928例,钢板内固定组917例。Meta分析结果显示:两种治疗方法在在尺偏角(MD=-0.72,95%CI:-1.35~-0.10,P=0.02);尺骨变异(MD=0.80,95%CI:0.59~1.01,P<0.001);旋前(MD=-2.60,95%CI:-4.88~-0.31,P=0.03);视觉模拟量表评分(MD=0.10,95%CI:0.02~0.17,P=0.01);感染率(RR=5.18,95%CI:2.50~10.73,P<0.001)等方面的差异有统计学意义,内固定组优于外固定组,而在掌倾角(MD=0.35,95%CI:-3.40~4.11,P=0.85);桡骨高度(MD=-0.50,95%CI:-1.26~0.27,P=0.21);握力(MD=-0.15,95%CI:-0.51~0.20,P=0.40);背伸(MD=-3.84,95%CI:-9.60~1.91,P=0.19);掌屈(MD=-2.12,95%CI:-6.47~2.24,P=0.34);旋后(MD=-3.22,95%CI:-6.46~0.02,P=0.05);桡偏(MD=-0.01,95%CI:-0.82~0.85,P=0.98);尺偏(MD=0.00,95%CI:-0.33~0.33,P=0.98);上肢功能障碍评定量表(DASH)评分(MD=0.07,95%CI:-3.02~3.16,P=0.96);并发症总发生率(RR=1.10,95%CI:0.94~1.27,P=0.23);复杂区域性疼痛综合征发生率(RR=1.70,95%CI:0.96~3.03,P=0.07)等方面差异无统计学意义。结论基于目前研究数据观察,切开复位钢板内固定组在术后尺偏角的恢复、尺骨变异、旋前活动、以及感染率等方面优于外固定组,而在掌倾角、术后桡骨高度的减缩、握力的恢复、桡、尺偏或旋后等活动度以及上肢功能障碍评分(disabilities of the arm,shoulder and hand,DASH)、总并发症的发生率等方面,差异无�Objective To evaluate the efficacy of external fixation after closed reduction and internal fixation with steel plate after open reduction in the treatment of distal radius fracture(DRF)using a systematic review.Methods We retrieved publicly available databases,such as Pubmed,CNKI,and Wanfang,and to collect randomized controlled trail(RCT)about these two kinds of public tables from the inception of the database to July 2023.The retrieved literature was screened manually,and for the final included studies,Cochrane risk bias assessment tool was used to assess the quality of bias risk,and RevMan 5.4 software was used for Meta-analysis.The advantages and disadvantages of the two postoperative imaging,functional scores and complications were compared.Results A total of 1845 patients were included in 20 RCT literatures,including 928 patients in external fixator group and 917 patients in internal fixation with steel plate group.Meta-analysis results showed that there were significant differences inthe two treatment methods with respect to the ulnar deviation angle(MD=-0.72,95%CI:-1.35--0.10,P=0.02)of the two treatments,ulna variation(MD=0.80,95%CI:0.59-1.01,P<0.001),pronation(MD=-2.60,95%CI:-4.88--0.31,P=0.03),visual analog scale(VAS)score(MD=0.10,95%CI:0.02-0.17,P=0.01),and the infection rate(RR=5.18,95%CI:2.50-10.73,P<0.001),and the internal fixation group was better than the external fixation group.However,there were no significant differences with respect to the palmar inclination angle(MD=0.35,95%CI:-3.40-4.11,P=0.85),height of radius(MD=-0.50,95%CI:-1.26-0.27,P=0.21),grip strength(MD=-0.15,95%CI:-0.51-0.20,P=0.40),dorsiflexion(MD=-3.84,95%CI:-9.60-1.91,P=0.19),palmar flexion(MD=-2.12,95%CI:-6.47-2.24,P=0.34),supination(MD=-3.22,95%CI:-6.46-0.02,P=0.05),radial deviation(MD=-0.01,95%CI:-0.82-0.85,P=0.98),ulnar deviation(MD=-0.00,95%CI:-0.33-0.33,P=0.98),the disabilities of the arm,shoulder,and hand(DASH)score(MD=0.07,95%CI:-3.02-3.16,P=0.96),the total incidence of complications(RR=1.10,95%CI:0.94-1.27,P=0.23),and th

关 键 词：肱骨骨折 外固定器 骨折固定术 内 

分 类 号：R683.41[医药卫生—骨科学]