摘要
背景:桡骨远端骨折的修复方法较多,克氏针与钢板置入内固定都是常见的修复方法,临床医生在固定方式的选择上存在较大灵活性,但目前国内外尚未见两者对桡骨远端骨折修复效果的比较。目的:系统评价克氏针与钢板置入内固定修复老年桡骨远端骨折安全及有效性的差异。方法:用循证医学的方法检索CBM、CNKI、VIP、PubM ed、Cochrane Library等数据库,并手工检索《中华骨科杂志》、《中华创伤骨科杂志》、《中华创伤杂志》、《实用骨科杂志》等。严格按照文献纳入、排除标准筛选文献,对纳入文献按照Cochrane手册评价方法进行质量评价,对符合标准的文献进行数据提取,利用Rev Man 5.2进行数据合并分析。结果与结论:共纳入9个随机对照试验。Meta分析结果显示,钢板组随访3个月上肢功能评分[MD=-4.55(-7.89,-1.21),P=0.008]、随访12个月上肢功能评分[MD=-3.13(-6.08,-0.18),P=0.004]均优于克氏针组,钢板组感染发生率低于克氏针组[OR=0.42(0.23,0.79),P=0.007]。复杂性局部痛综合征发生率[OR=0.28(0.05,1.38),P=0.12]、腕管综合征发生率[OR=0.75(0.20,2.76),P=0.66]、肌腱损伤[OR=1.66(0.51,5.41),P=0.64]方面钢板组及克氏针组差异无显著性意义。提示与克氏针相比,钢板置入内固定在修复老年桡骨远端骨折过程中更为安全有效,在经济情况允许下,建议老年骨质疏松桡骨远端骨折的患者尽量行钢板内固定。
BACKGROUND： There are many ways for surgical treatment of distal radius fractures. Both volar locking plates and Kirschner wires are common methods. Doctors have considerable flexibility in the choice of the ways of fixation, but both at home and abroad there is no comparison between the effects of the two operations for treating distal radius fractures. OBJECTIVE： To systematically review the differences in effectiveness and safety of volar locking plates versus Kirschner wires for distal radial fracture. METHODS： Databases such as CBM, CNKI, VIP, PubM ed and Cochrane Library were electronically searched. Chinese Journal of Orthopaedics, Chinese Journal of Orthopaedic Trauma, Chinese Journal of Trauma and Journal of Practical Orthopaedics were searched by hand. In strict accordance with inclusion and exclusion criteria, articles were screened. Methodological quality of included studies was evaluated according to Cochrane Handbook. Data were extracted, and then analyzed with Rev Man 5.2 software. RESULTS AND CONCLUSION： Nine randomized controlled trials were included. Meta-analysis results demonstrated that upper limb function scores were better in the volar locking plate group than in the Kirschner wire group [MD=-4.55（-7.89,-1.21）, P=0.008] at 3 months of follow-up and [MD=-3.13（-6.08,-0.18）, P=0.004] at 12 months. The incidence of infection was lower in the volar locking plate group than in the Kirschner wire group [OR= 0.42（0.23, 0.79）, P=0.007]. No significant difference in incidence of complex regional pain syndrome [OR=0.28（0.05, 1.38）, P=0.12], incidence of carpal tunnel syndrome [OR=0.75（0.20, 2.76）, P=0.66] and tendon injury [OR= 1.66（0.51, 5.41）, P=0.64] was detected between the volar locking plate group and Kirschner wire group. These results indicated that compared with the Kirschner wire, volar locking plate fixation for the repair of distal radial fracture is safe and effective. In the permission of economic circumstances, it is suggested that elder osteoporosis pati
出处
《中国组织工程研究》
CAS
北大核心
2016年第9期1361-1368,共8页
Chinese Journal of Tissue Engineering Research
