闭合复位外固定架固定与切开复位内固定治疗不稳定型成人桡骨远端骨折有效性及安全性的系统评价_《中国循证医学杂志》

作者：

 陈明 ¹ , 赵劲民 ² , 李兵 ¹ , 彭小忠 ¹ , 丁晓飞 ² , 苏伟 ² , 沙轲 ² , 石展英 ¹ , 武振国等 ¹

1. 柳州市工人医院骨二科（柳州 545005）；2. 广西医科大学第一附属医院创伤骨科手外科（南宁 530021）;

关键词：

桡骨远端骨折闭合复位外固定架固定切开复位内固定成人随机对照试验系统评价 Meta分析

DOI：

10.7507/1672-2531.20100583

视频：

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目的　系统评价闭合复位外固定架固定（EF）与切开复位内固定（ORIF）治疗不稳定型成人桡骨远端骨折的有效性及安全性。
方法　计算机检索CENTRAL（2008年第3期）、PubMed（1966～2008.9）、EMbase（1974～2008.9）、中国生物医学文献数据库（1978～2008.9）、中文期刊全文数据库（1979～2008.9），并辅以检索临床信息网站等寻找正在进行尚未完成或已完成未发表的随机对照试验。检索策略参考Cochrane Handbook 5.0，检索语种不限。由两位研究者对纳入文献进行质量评价和资料提取后，采用RevMan 5.0软件进行Meta分析。
结果　共纳入6个随机对照试验，634例患者，其中EF组269例，ORIF组293例。Meta分析结果显示：① 疗效：根据GW评分标准，ORIF组优良率优于EF组，其差异有统计学意义［RR=1.50，95%CI（1.11，2.03），P=0.008］，但评分为一般及差者差异无统计学意义［RR=0.30，95%CI（0.05，1.69），P=0.17］；② 并发症：EF组钉道感染率高于ORIF组，差异有统计学意义［RR=0.24，95%CI（0.08，0.76），P=0.02］；反射性交感神经营养不良症（RSD）发生率［RR=0.88，95%CI（0.30，2.56），P=0.82］、伸肌腱断裂率［RR=3.93，95%CI（0.45，34.62），P=0.22］、间室综合征发生率［RR=3.13，95%CI（0.51，19.09），P=0.22］两组无明显差异。
结论　EF治疗成人不稳定型桡骨远端骨折在GW评分上优于ORIF组，钉道感染率EF高于ORIF组。但因本次系统评价纳入病例数较少，文献质量参差不齐，故尚需开展更多设计严谨的大样本随机对照试验来增加证据的论证强度。

引用本文： 陈明,赵劲民,李兵,彭小忠,丁晓飞,苏伟,沙轲,石展英,武振国等. 闭合复位外固定架固定与切开复位内固定治疗不稳定型成人桡骨远端骨折有效性及安全性的系统评价. 中国循证医学杂志, 2010, 10(11): 1269-1275. doi: 10.7507/1672-2531.20100583 复制

1.	于吉胜, 蔡锦方. 腕关节外科学. 北京: 人民卫生出版社, 2002: 241.
2.	Edwards CC 2nd, Haraszti CJ, Mcillivary GR, et al. Intra-articular distal radius fractures: arthroscopic assessment of radiographically assisted reduction. J Hand Surg Am, 2001, 26(6): 1036-1041.
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8.	Rogachefsky RA, Lipson SR, Applegate B, et al. Treatment of severely comminuted intraarticular fractures of the distal end of the radius by open reduction and combined internal and external fixation. J Bone Joint Surg, 2001, 83-A(4): 509-519.
9.	Constantine KJ, Clawson MC, Stern PJ. Volar neutralization plate fixation of dorsally displaced distal radius fractures. Orthopedics, 2002, 25(2): 125-128.
10.	Gartland JJ Jr, Werley CW. Evaluation of healed colles fractures. J Bone Joint Surg Am, 1951, 33-A(4): 895-907.
11.	Trumble TE, Schmitt SR, Vedder NB. Factors affecting Functional outcome of displaced intra-articular distal radius fractures. J Hand Surg, 1994, 19(2): 325-340.
12.	Axelrod T, Paley D, Green J. Limited open reduction of the lunate facet in comminuted intra-articular fractures of the distal radius. J Hand Surg, 1988, 13(3): 372-277.
13.	Bradway JK, Amadio PC, Cooney WP. Open reduction and internal fixation of displaced, comminuted intra-articular fractures of the distal end of the radius. J Bone Joint Surg, 1989, 71(6): 839-847.
14.	Jupiter JB, Lipton H. The operative treatment of intraarticular fractures of the distal radius. Clin Orthop, 1993, (292): 48-61.
15.	Gesensway D, Putnam MD, Mente PL, et al. Design and biomechanics of a plate for the distal radius. J Hand Surg, 1995, 20(6):1021-1027.
16.	Ring D, Jupiter JB. Operative fixation of fractures of the distal radius using the plate. Tech Hand Upper Extremity Surg, 1997, 1(2): 125-130.
17.	Higgins JPT, Altman DG. Assessing risk of bias in included studies. Cochrane Handbook for Systematic Reviews of Interventions Version 5.0.0 (updated February 2008). The Cochrane Collaboration, 2008. Available from www.cochrane- handbook.org.
18.	吴泰相, 刘关健. 隐蔽分组(分配隐藏)和盲法的概念、实施与报告. 中国循证医学杂志, 2007, 7(3): 222-225.
19.	Grewal R, Perey B, Wilmink M, et al. A randomized prospective study on the treatment of intra-articular distal radius fractures: open reduction and internal fixation with dorsal plating verse mini open reduction, and external fixation. J Hand Surg Am, 2005, 30(4): 764-772.
20.	Kreder HJ, Hanel DP, Agel J. Indirect reduction and percutaneous fixation versus open reduction and internal fixation for displaced intra-articular fractures of the distal radius a radomised, controlled trial. Bone Joint Surg [Br], 2005, 87(6): 829-836.
21.	McQueen MM, Hajducka C, Court-Brown CM. Redisplaced unstable fractures of the distal radius: a prospective randomised comparison of four methods of treatment. J Bone Joint Surg Br, 1996, 78(3): 404-409.
22.	Leung F, Tu YK, Chew WYC, et al. Comparison of External and Percutaneous Pin Fixation with Plate Fixation for Intra-articular Distal Radial Fractures. A Randomized Study. J Bone Joint Surg Am, 2008, 90(1): 16-22.
23.	Kapoor H, Agarwal A, Dhaon BK. Displaced intra-articular fractures of distal radius: a comparative evaluation of results following closed reduction, external fixation and open reduction with internal fixation. Injury, 2000, 31(2): 75-79.
24.	马楚平, 何光联, 梁江山, 等. 桡骨外固定器和钢板内固定治疗桡骨远端不稳定骨折的效果比较. 广东医学院学报, 2008, 26(4): 24-26.
25.	Handoll HHG, Madhok R. Surgical interventions for treating distal radial fractures in adults. Cochrane Database Syst Rev, 2009, 8(3): CD003209.

1. 于吉胜, 蔡锦方. 腕关节外科学. 北京: 人民卫生出版社, 2002: 241.
2. Edwards CC 2nd, Haraszti CJ, Mcillivary GR, et al. Intra-articular distal radius fractures: arthroscopic assessment of radiographically assisted reduction. J Hand Surg Am, 2001, 26(6): 1036-1041.
3. Kamano M, Honda Y, Kazuki K. Palmar plating for dorsally displaced fractures of the distal radius. Zentralbl Chir, 2003, 128(12): 997-1002.
4. Lee HC, Wong YS, Chan BK, et al. Fixation of distal radius fractures Using AOtitanium volar distal radius plate. Hand Surg, 2003, 8(1): 7-15.
5. Ring D, Prommersberger K, Jupiter JB. Combined dorsal and volar plate fixation of complex fractures of the distal part of the radius. J Bone Joint Surg, 2004, 86-A(8): 1646-1652.
6. Konrath GA, Bahler S. Open reduction and internal fixation of unstable distal radius fractures: results using the TriMed fixation system. J Orthop Trauma, 2002, 16(8): 578-585.
7. Wiesler ER, Chloros GD, Lucas RM. Arthroscopic management of volar lunate facet fractures of the distal radius. Tech Hand Up Extrem Surg, 2006, 10(3): 139-144.
8. Rogachefsky RA, Lipson SR, Applegate B, et al. Treatment of severely comminuted intraarticular fractures of the distal end of the radius by open reduction and combined internal and external fixation. J Bone Joint Surg, 2001, 83-A(4): 509-519.
9. Constantine KJ, Clawson MC, Stern PJ. Volar neutralization plate fixation of dorsally displaced distal radius fractures. Orthopedics, 2002, 25(2): 125-128.
10. Gartland JJ Jr, Werley CW. Evaluation of healed colles fractures. J Bone Joint Surg Am, 1951, 33-A(4): 895-907.
11. Trumble TE, Schmitt SR, Vedder NB. Factors affecting Functional outcome of displaced intra-articular distal radius fractures. J Hand Surg, 1994, 19(2): 325-340.
12. Axelrod T, Paley D, Green J. Limited open reduction of the lunate facet in comminuted intra-articular fractures of the distal radius. J Hand Surg, 1988, 13(3): 372-277.
13. Bradway JK, Amadio PC, Cooney WP. Open reduction and internal fixation of displaced, comminuted intra-articular fractures of the distal end of the radius. J Bone Joint Surg, 1989, 71(6): 839-847.
14. Jupiter JB, Lipton H. The operative treatment of intraarticular fractures of the distal radius. Clin Orthop, 1993, (292): 48-61.
15. Gesensway D, Putnam MD, Mente PL, et al. Design and biomechanics of a plate for the distal radius. J Hand Surg, 1995, 20(6):1021-1027.
16. Ring D, Jupiter JB. Operative fixation of fractures of the distal radius using the plate. Tech Hand Upper Extremity Surg, 1997, 1(2): 125-130.
17. Higgins JPT, Altman DG. Assessing risk of bias in included studies. Cochrane Handbook for Systematic Reviews of Interventions Version 5.0.0 (updated February 2008). The Cochrane Collaboration, 2008. Available from www.cochrane- handbook.org.
18. 吴泰相, 刘关健. 隐蔽分组(分配隐藏)和盲法的概念、实施与报告. 中国循证医学杂志, 2007, 7(3): 222-225.
19. Grewal R, Perey B, Wilmink M, et al. A randomized prospective study on the treatment of intra-articular distal radius fractures: open reduction and internal fixation with dorsal plating verse mini open reduction, and external fixation. J Hand Surg Am, 2005, 30(4): 764-772.
20. Kreder HJ, Hanel DP, Agel J. Indirect reduction and percutaneous fixation versus open reduction and internal fixation for displaced intra-articular fractures of the distal radius a radomised, controlled trial. Bone Joint Surg [Br], 2005, 87(6): 829-836.
21. McQueen MM, Hajducka C, Court-Brown CM. Redisplaced unstable fractures of the distal radius: a prospective randomised comparison of four methods of treatment. J Bone Joint Surg Br, 1996, 78(3): 404-409.
22. Leung F, Tu YK, Chew WYC, et al. Comparison of External and Percutaneous Pin Fixation with Plate Fixation for Intra-articular Distal Radial Fractures. A Randomized Study. J Bone Joint Surg Am, 2008, 90(1): 16-22.
23. Kapoor H, Agarwal A, Dhaon BK. Displaced intra-articular fractures of distal radius: a comparative evaluation of results following closed reduction, external fixation and open reduction with internal fixation. Injury, 2000, 31(2): 75-79.
24. 马楚平, 何光联, 梁江山, 等. 桡骨外固定器和钢板内固定治疗桡骨远端不稳定骨折的效果比较. 广东医学院学报, 2008, 26(4): 24-26.
25. Handoll HHG, Madhok R. Surgical interventions for treating distal radial fractures in adults. Cochrane Database Syst Rev, 2009, 8(3): CD003209.

《中国循证医学杂志》

闭合复位外固定架固定与切开复位内固定治疗不稳定型成人桡骨远端骨折有效性及安全性的系统评价

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《中国循证医学杂志》

闭合复位外固定架固定与切开复位内固定治疗不稳定型成人桡骨远端骨折有效性及安全性的系统评价

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