切开复位T形钢板固定术治疗桡骨远端骨折的荟萃分析

摘要

目的比较切开复位T形钢板固定术与单纯手法复位石膏外固定治疗桡骨远端骨折的疗效差异,以期为临床上治疗桡骨远端骨折选择合适的治疗方案提供依据.方法 按Cochrane系统评价的方法,计算机检索PubMed、Cochrane Library、EMBASE、Medline、CNKI、CBM、维普和万方数据库,同时手工检索中文骨外科期刊的相关文献,收集关于桡骨远端骨折经切开复位T形钢板固定术对比手法复位石膏外固定治疗的随机对照试验(RCT),检索时限均为建库至2012年1月31日.按纳入排除标准由两人独立进行RCT的筛选、资料提取和质量评价后,采用RevMan5.1软件进行荟萃分析.结果 最终纳入3个符合要求的RCT研究,共171例患者.荟萃分析发现,与手法复位石膏外固定治疗相比,切开复位T形钢板固定术对改善桡骨轴向缩短长度更有效,两组差异有统计学意义(MD=-1.98,95%CI -3.12 ～0.84,P＜0.05),对掌倾角的恢复无统计学意义(MD=1.69,95%CI -0.3 ～3.41,P=0.05)、对尺偏角的恢复无统计学意义(MD=-1.50,95%CI -5.47 ～2.47,P＞0.05).结论 切开复位T形钢板固定术与单纯手法复位石膏外固定治疗桡骨远端骨折均能改善患者症状,临床疗效相似.但因原始研究质量均较低,影响结论的真实性,故建议临床医师参考,同时应该关注患者的要求及期望值.%Objective To compare the therapeutic effect of open reduction and T-plate fixation with simple manual reduction and plaster fixation for the treatment of distal radius iiactuies to provide references for the appropriate treatment selection. Methods Such datebases as PubMed, Cochrane Library, EMBASE , Medline, CNKI, CBM, VIP and Wanfang were searched from their establishment to January 3 1 st 2012 for collecting the RCT about open reduction and T-plate fixation VS simple manual reduction and plaster fixation for the treatment of distal radius fractures, and the references of those RCTs were also searched from printed Chinese journals of oithopedic surgery by hand. After study selection, assessment and date extraction were conducted by two reviewers independently, meta-analyses were performed by RevMan 5. 1 software. Results Three studies involving 171 patients were included. The results of meta-analyses showed that: open reduction and iixation of the T-plate was more effective than manual reduction and plaster external fixationin impiov-ingthe radial axial length( the difference was statistically significant ,MD = - 1. 98 ,95 % CI - 3. 12 -0. 84 , P ＜ 0. 05 ), there was no significant differences of the recovery of palm dip( MD = 1. 69 ,95 % CI -0.3-3. 41 , P = 0. 05 ), there was no significant differences of the recovery of ulnar deviation( MD = -1.50,95% CI -5.47-2.47,P＞0. 05 ). Conclusion Open reduction and T-plate fixation and simple manual reduction and plaster external fixation can both improve symptoms in patients of distal radius iiactuies with similar clinical efficacy. However,due to the lower quality of the original research affecting the authenticity of the conclusions, it is suggested that clinicians should be concerned about the patient's requirements and expectations when referring to the conclusion.