老年人桡骨远端骨折治疗后腕关节屈伸及旋转活动的Meta分析

背景：目前老年桡骨远端骨折是否需切开复位钢板内固定以恢复影像学上的解剖复位还存在争议。目的：对老年人桡骨远端骨折手术与非手术治疗的疗效进行系统评价。方法：计算机检索PubMed，Springer以及万方等数据库，手工检索相关的中英文骨科杂志。收集所有对手术与非手术治疗老年人桡骨远端骨折疗效进行比较的文献。利用Cochrane协作网提供的RevMan5.0软件进行统计学分析。结果与结论：共纳入符合标准的文献6篇，其中随机对照研究2篇，回顾性队列研究4篇。Meta分析结果显示：两组腕关节背伸活动度[MD=-0.87，95% CI(-3.31,1.58)，P=0.49]，屈曲活动度[MD=-2.79，95% CI(-6.47,0.88)，P=0.14]，旋前活动度[MD=-0.08，95% CI(-1.49,1.64)，P =0.92]，旋后活动度[MD=-0.7，95% CI(-3.52，2.12)，P=0.63]以及并发症的发生[MD=1.35，95% CI(0.71,2.56)，P=0.36] 差异均无显著性意义；手术组桡骨长度更接近于正常的解剖长度[MD=2.46，95% CI(1.78,3.15)，P < 0.01]；手术组尺倾角 [MD=3.73，95% CI(2.97，4.48)，P < 0.000 01]以及掌倾角[MD=6.81，95% CI(3.72,9.90)，P < 0.000 1]更接近于正常的解剖角度。两组患肢腕关节屈伸，旋前旋后活动度以及并发症的发生差异均无显著性意义，而手术组解剖复位程度明显优于非手术组。中国组织工程研究杂志出版内容重点：人工关节；骨植入物；脊柱；骨折；内固定；数字化骨科；组织工程全文链接：

Meta analysis of flexion,extension and rotation of wrist joint in the elderly with distal radius fractures after treatment

BACKGROUND:At present, it remains controversial whether open reduction plate fixation is needed for distal radius fracture in the elderly to restore anatomic reduction of imaging. OBJECTIVE:To systematically evaluate the curative effects of operative and nonoperative treatments for distal radius fractures in the elderly.  METHODS:We retrieved PubMed, Springer and Wanfang database using computer. Relevant English and Chinese journals of orthopedics were retrieved by hand. All literatures on curative effects of operative and nonoperative treatments for distal radius fractures in the elderly were collected. RevMan 5.0 software provided by Cochrane was used to statistically analyze the data. RESULTS AND CONCLUSION:Six literatures were included, including two of randomized controlled study and four of retrospective cohort study. Meta-analysis results displayed that there were no significant differences in both groups in range of motion of wrist joint extension [mean difference (MD)=-0.87, 95% confidence interval (CI) (-3.31, 1.58), P=0.49], range of motion of wrist joint flexion [MD=-2.79, 95%CI(-6.47, 0.88), P=0.14], range of motion of wrist pronation [MD=-0.08, 95%CI(-1.49, 1.64), P=0.92], range of motion of supination [MD=-0.7, 95% CI(-3.52, 2.12), P=0.63] and the occurrence of complication [MD=1.35, 95%CI(0.71, 2.56), P=0.36]. The length of radius in the surgery group was similar to that of normal [MD=2.46, 95%CI(1.78, 3.15), P < 0.01]. Ulnar inclination [MD=3.73, 95%CI(2.97, 4.48), P < 0.000 01] and palmar tilt angle [MD=6.81, 95%CI(3.72, 9.90), P < 0. 000 1] in the surgery group were close to that of normal. There are no significant differences in extension, flexion, pronation and supination activities of wrist and posttreatment complication between two groups. Operative treatment result is superior to that of nonoperative treatment in anatomic reduction.