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Meta分析

Safety and effectiveness of Kirschner wire and plate fixation for treating distal radial fracture in the elderly: a meta-analysis

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, PubMed 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 RevMan 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 patients with distal radial fracture should receive plate fixation.