閉合復位外固定架固定與切開復位內固定治療不穩定型成人橈骨遠端骨折有效性及安全性的系統評價_《中國循證醫學雜志》

作者：

 陳明 ¹ , 趙勁民 ² , 李兵 ¹ , 彭小忠 ¹ , 丁曉飛 ² , 蘇偉 ² , 沙軻 ² , 石展英 ¹ , 武振國等 ¹

1. 柳州市工人醫院骨二科（柳州 545005）；2. 廣西醫科大學第一附屬醫院創傷骨科手外科（南寧 530021）;

關鍵詞：

橈骨遠端骨折閉合復位外固定架固定切開復位內固定成人隨機對照試驗系統評價 Meta分析

DOI：

10.7507/1672-2531.20100583

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目的　系統評價閉合復位外固定架固定（EF）與切開復位內固定（ORIF）治療不穩定型成人橈骨遠端骨折的有效性及安全性。
方法　計算機檢索CENTRAL（2008年第3期）、PubMed（1966～2008.9）、EMbase（1974～2008.9）、中國生物醫學文獻數據庫（1978～2008.9）、中文期刊全文數據庫（1979～2008.9），并輔以檢索臨床信息網站等尋找正在進行尚未完成或已完成未發表的隨機對照試驗。檢索策略參考Cochrane Handbook 5.0，檢索語種不限。由兩位研究者對納入文獻進行質量評價和資料提取后，采用RevMan 5.0軟件進行Meta分析。
結果　共納入6個隨機對照試驗，634例患者，其中EF組269例，ORIF組293例。Meta分析結果顯示：① 療效：根據GW評分標準，ORIF組優良率優于EF組，其差異有統計學意義［RR=1.50，95%CI（1.11，2.03），P=0.008］，但評分為一般及差者差異無統計學意義［RR=0.30，95%CI（0.05，1.69），P=0.17］；② 并發癥：EF組釘道感染率高于ORIF組，差異有統計學意義［RR=0.24，95%CI（0.08，0.76），P=0.02］；反射性交感神經營養不良癥（RSD）發生率［RR=0.88，95%CI（0.30，2.56），P=0.82］、伸肌腱斷裂率［RR=3.93，95%CI（0.45，34.62），P=0.22］、間室綜合征發生率［RR=3.13，95%CI（0.51，19.09），P=0.22］兩組無明顯差異。
結論　EF治療成人不穩定型橈骨遠端骨折在GW評分上優于ORIF組，釘道感染率EF高于ORIF組。但因本次系統評價納入病例數較少，文獻質量參差不齊，故尚需開展更多設計嚴謹的大樣本隨機對照試驗來增加證據的論證強度。

引用本文： 陳明,趙勁民,李兵,彭小忠,丁曉飛,蘇偉,沙軻,石展英,武振國等. 閉合復位外固定架固定與切開復位內固定治療不穩定型成人橈骨遠端骨折有效性及安全性的系統評價. 中國循證醫學雜志, 2010, 10(11): 1269-1275. doi: 10.7507/1672-2531.20100583 復制

1.	于吉勝, 蔡錦方. 腕關節外科學. 北京: 人民衛生出版社, 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.	吳泰相, 劉關健. 隱蔽分組(分配隱藏)和盲法的概念、實施與報告. 中國循證醫學雜志, 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.	馬楚平, 何光聯, 梁江山, 等. 橈骨外固定器和鋼板內固定治療橈骨遠端不穩定骨折的效果比較. 廣東醫學院學報, 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. 于吉勝, 蔡錦方. 腕關節外科學. 北京: 人民衛生出版社, 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. 吳泰相, 劉關健. 隱蔽分組(分配隱藏)和盲法的概念、實施與報告. 中國循證醫學雜志, 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. 馬楚平, 何光聯, 梁江山, 等. 橈骨外固定器和鋼板內固定治療橈骨遠端不穩定骨折的效果比較. 廣東醫學院學報, 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.

《中國循證醫學雜志》

閉合復位外固定架固定與切開復位內固定治療不穩定型成人橈骨遠端骨折有效性及安全性的系統評價

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《中國循證醫學雜志》

閉合復位外固定架固定與切開復位內固定治療不穩定型成人橈骨遠端骨折有效性及安全性的系統評價

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