外固定架与切开复位内固定治疗桡骨远端骨折Meta分析

目的:通过Meta分析评价钢板内固定(open reduction and internal fixation,ORIF)与外固定架(external fix-ator,EF)固定治疗桡骨远端骨折的临床疗效及安全性.方法:通过计算机检索数据库,包括中国知网(CNKI)、维普(VIP)、万方数据(Wanfang Data...

Meta-analysis of external fixator and open reduction and internal fixation for the treatment of distal radius fracture

Objective: To compare clinical efficacy and safety of plate internal fixation (ORIF) and external fixator (EF) in treating distal radius fractures by Meta-analysis.Methods: From establishment of database to August, 2019, randomized controlled trial (RCT) about open reduction and internal fixation (ORIF) and external fixation (EF) in treating distal radius fractures was conducted by using computer-based databases, including CNKI, VIP, Wanfang Data, Medline, Cochrane library databases. Data extraction and quality evaluation of included study according to inclusion and exclusion criteria, RevMan 5.3 software was used to perform Meta-analysis. Palm angle, ulnar deflection angle, radius height, grip strength, ulnar variation, disabilities of arm, shoulder and hand(DASH) score, total complication rate, infection rate and tendon rupture between two groups were compared.Results: Totally 19 RCT were included with 1 730 patients, 873 patients in ORIF group and 857 patients in EF group. Meta-analysis result showed that after operation at 12 months, there were no significant difference in radial heightMD=0.04, 95%CI(-0.90, 0.99), P=0.93], tendon ruptureRR=1.82, 95%CI(0.71, 4.67), P=0.21], carpal tunnel syndromeRR=2.15, 95%CI(0.98, 4.70), P=0.06], complex regional pain syndromRR=0.63, 95%CI(0.31, 1.27)P=0.78] between two groups. While there were significant difference in palm inclination angleMD=1.38, 95%CI(0.83, 1.93), P<0.000 01], ulnar deflection angleMD=0.99, 95%CI(0.54, 1.45), P<0.000 1], ulna variabilityMD=0.66, 95%CI(0.21, 1.12), P=0.005], DASH scoreMD=2.42, 95%CI(0.37, 4.46), P=0.02], incidence of complicationsRR=0.83, 95%CI(0.71, 0.96), P=0.01], infection rateRR=0.20, 95%CI(0.11, 0.36), P<0.000 1]between two groups. There was statistical difference in tendinitis incidence between two groupsMD=3.88, 95%CI(1.56, 9.64), P<0.003].Conclusion: Compared with EF in treating distal radius fracture, ORIF has better clinical effects in postoperative complications, palm angle, ulnar deviation angle, ulnar variation rate and infection rate. While there were no significant difference between in DASH score, radial height, tendon rupture and carpal tunnel syndrome better EF and ORIF. For the patient pursue rapid recovery of function, ORIF is better choice.