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[1]呂德梁,李國(guó)梁,趙建勇,等.不同手術(shù)方法治療橈骨遠(yuǎn)端骨折臨床療效和安全性的網(wǎng)狀Meta分析[J].中醫(yī)正骨,2025,37(01):9-19,25.
　LYU Deliang,LI Guoliang,ZHAO Jianyong,et al.Clinical efficacy and safety of different surgical procedures in treatment of distal radius fractures:a network meta-analysis[J].The Journal of Traditional Chinese Orthopedics and Traumatology,2025,37(01):9-19,25.
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不同手術(shù)方法治療橈骨遠(yuǎn)端骨折臨床療效和安全性的網(wǎng)狀Meta分析()
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《中醫(yī)正骨》[ISSN:1001-6015/CN:41-1162/R]

卷:
第37卷
期數(shù):
2025年01期
頁碼:
9-19,25
欄目:
橈骨遠(yuǎn)端骨折
出版日期:
2025-01-20

文章信息/Info

Title:
Clinical efficacy and safety of different surgical procedures in treatment of distal radius fractures:a network meta-analysis
作者:
呂德梁1; 李國(guó)梁1; 趙建勇2; 王鑫3; 袁野1; 王鐵強(qiáng)1; 王旭洋1; 劉文東1; 沈潤(rùn)斌1
1.河北省滄州中西醫(yī)結(jié)合醫(yī)院,河北 滄州 061001; 2.河北省中西醫(yī)結(jié)合醫(yī)學(xué)3D打印技術(shù)創(chuàng)新中心,河北 滄州 061001; 3.華北理工大學(xué)中醫(yī)學(xué)院,河北 唐山 063210
Author(s):
LYU Deliang1; LI Guoliang1; ZHAO Jianyong2; WANG Xin3; YUAN Ye1; WANG Tieqiang1; WANG Xuyang1; LIU Wendong1; SHEN Runbin1
1.Cangzhou Hospital of Integrated TCM-WM·Hebei,Cangzhou 061001,Hebei,China2.Hebei Provincial 3D Printing Technology Innovation Center of Integrated Traditional Chinese and Western Medicine,Cangzhou 061001,Hebei,China 3.College of Traditional Chinese Medicine,North China University of Science and Technology,Tangshan 063210,Hebei,China
關(guān)鍵詞:
橈骨骨折;  骨折閉合復(fù)位;  骨折切開復(fù)位;  骨折固定術(shù); 內(nèi);  伊利扎羅夫技術(shù);  網(wǎng)絡(luò)Meta分析
Keywords:
radius fractures;  closed fracture reduction;  open fracture reduction;  fracture fixation; internal;  Ilizarov technique;  network meta-analysis
摘要:
目的:系統(tǒng)評(píng)價(jià)不同手術(shù)方法治療橈骨遠(yuǎn)端骨折的臨床療效和安全性。方法:應(yīng)用計(jì)算機(jī)檢索中國(guó)知網(wǎng)、維普網(wǎng)、萬方數(shù)據(jù)庫、中國(guó)生物醫(yī)學(xué)文獻(xiàn)服務(wù)系統(tǒng)、PubMed、Embase、Cochrane Library、Web of Science中關(guān)于手術(shù)方法治療橈骨遠(yuǎn)端骨折的隨機(jī)對(duì)照試驗(yàn),檢索時(shí)限均為建庫至2024年6月1日。試驗(yàn)組和對(duì)照組均采用手術(shù)方法治療。依據(jù)文獻(xiàn)檢索及篩選方案篩選出符合要求的文獻(xiàn)后,由2名研究人員分別獨(dú)立進(jìn)行數(shù)據(jù)提取和質(zhì)量評(píng)價(jià)。采用Stata15.0軟件繪制網(wǎng)狀關(guān)系圖,對(duì)療效優(yōu)良率、并發(fā)癥發(fā)生情況及腕關(guān)節(jié)橈偏、尺偏、掌屈、背伸、旋前、旋后活動(dòng)度進(jìn)行網(wǎng)狀Meta分析,并根據(jù)累計(jì)概率排名曲線下面積(the surface under the cumulative ranking curve,SUCRA)對(duì)手術(shù)方法的療效進(jìn)行排序。采用比較-校正漏斗圖進(jìn)行發(fā)表偏倚檢驗(yàn)。結(jié)果:共檢索到 10 320 篇文獻(xiàn),通過逐層篩選最終納入34篇文獻(xiàn),涉及切開復(fù)位鋼板內(nèi)固定、閉合復(fù)位支架外固定、閉合復(fù)位克氏針內(nèi)固定、閉合復(fù)位髓內(nèi)釘內(nèi)固定、腕關(guān)節(jié)鏡技術(shù)聯(lián)合切開復(fù)位鋼板內(nèi)固定、切開復(fù)位鋼板內(nèi)固定聯(lián)合局部植骨6種手術(shù)方法。網(wǎng)狀Meta分析結(jié)果顯示,在療效優(yōu)良率方面,不同手術(shù)方法治療橈骨遠(yuǎn)端骨折的療效排序?yàn)橥箨P(guān)節(jié)鏡技術(shù)聯(lián)合切開復(fù)位鋼板內(nèi)固定(SUCRA=99.90%)>切開復(fù)位鋼板內(nèi)固定(SUCRA=49.80%)>閉合復(fù)位支架外固定(SUCRA=41.50%)>閉合復(fù)位克氏針內(nèi)固定(SUCRA=8.80%); 在腕關(guān)節(jié)橈偏活動(dòng)度方面,不同手術(shù)方法治療橈骨遠(yuǎn)端骨折的療效排序?yàn)橥箨P(guān)節(jié)鏡技術(shù)聯(lián)合切開復(fù)位鋼板內(nèi)固定(SUCRA=85.10%)>閉合復(fù)位克氏針內(nèi)固定(SUCRA=84.70%)>閉合復(fù)位髓內(nèi)釘內(nèi)固定(SUCRA=41.90%)>切開復(fù)位鋼板內(nèi)固定(SUCRA=36.20%)>閉合復(fù)位支架外固定(SUCRA=2.00%); 在腕關(guān)節(jié)尺偏活動(dòng)度方面,不同手術(shù)方法治療橈骨遠(yuǎn)端骨折的療效排序?yàn)榍虚_復(fù)位鋼板內(nèi)固定(SUCRA=86.90%)>閉合復(fù)位髓內(nèi)釘內(nèi)固定(SUCRA=67.90%)>閉合復(fù)位克氏針內(nèi)固定(SUCRA=43.50%)>閉合復(fù)位支架外固定(SUCRA=36.90%)>腕關(guān)節(jié)鏡技術(shù)聯(lián)合切開復(fù)位鋼板內(nèi)固定(SUCRA=14.70%); 在腕關(guān)節(jié)掌屈活動(dòng)度方面,不同手術(shù)方法治療橈骨遠(yuǎn)端骨折的療效排序?yàn)橥箨P(guān)節(jié)鏡技術(shù)聯(lián)合切開復(fù)位鋼板內(nèi)固定(SUCRA=87.10%)>閉合復(fù)位髓內(nèi)釘內(nèi)固定(SUCRA=65.90%)>閉合復(fù)位克氏針內(nèi)固定(SUCRA=62.30%)>切開復(fù)位鋼板內(nèi)固定(SUCRA=34.00%)>閉合復(fù)位支架外固定(SUCRA=0.70%); 在腕關(guān)節(jié)背伸活動(dòng)度方面,不同手術(shù)方法治療橈骨遠(yuǎn)端骨折的療效排序?yàn)榍虚_復(fù)位鋼板內(nèi)固定(SUCRA=90.80%)>閉合復(fù)位髓內(nèi)釘內(nèi)固定(SUCRA=69.40%)>閉合復(fù)位克氏針內(nèi)固定(SUCRA=33.90%)>閉合復(fù)位支架外固定(SUCRA=32.90%)>腕關(guān)節(jié)鏡技術(shù)聯(lián)合切開復(fù)位鋼板內(nèi)固定(SUCRA=23.10%); 在腕關(guān)節(jié)旋前活動(dòng)度方面,不同手術(shù)方法治療橈骨遠(yuǎn)端骨折的療效排序?yàn)榍虚_復(fù)位鋼板內(nèi)固定(SUCRA=93.50%)>閉合復(fù)位髓內(nèi)釘內(nèi)固定(SUCRA=59.00%)>閉合復(fù)位支架外固定(SUCRA=41.30%)>閉合復(fù)位克氏針內(nèi)固定(SUCRA=32.50%)>腕關(guān)節(jié)鏡技術(shù)聯(lián)合切開復(fù)位鋼板內(nèi)固定(SUCRA=23.80%); 在腕關(guān)節(jié)旋后活動(dòng)度方面,不同手術(shù)方法治療橈骨遠(yuǎn)端骨折的療效排序?yàn)榍虚_復(fù)位鋼板內(nèi)固定(SUCRA=89.80%)>閉合復(fù)位支架外固定(SUCRA=55.80%)>閉合復(fù)位髓內(nèi)釘內(nèi)固定(SUCRA=54.80%)>閉合復(fù)位克氏針內(nèi)固定(SUCRA=27.60%)>腕關(guān)節(jié)鏡技術(shù)聯(lián)合切開復(fù)位鋼板內(nèi)固定(SUCRA=22.00%); 在并發(fā)癥發(fā)生情況方面,不同手術(shù)方法治療橈骨遠(yuǎn)端骨折的安全性排序?yàn)榍虚_復(fù)位鋼板內(nèi)固定聯(lián)合局部植骨(SUCRA=85.70%)>腕關(guān)節(jié)鏡技術(shù)聯(lián)合切開復(fù)位鋼板內(nèi)固定(SUCRA=71.40%)>閉合復(fù)位髓內(nèi)釘內(nèi)固定(SUCRA=58.30%)>閉合復(fù)位克氏針內(nèi)固定(SUCRA=47.30%)>切開復(fù)位鋼板內(nèi)固定(SUCRA=25.00%)>閉合復(fù)位支架外固定(SUCRA=12.30%)。結(jié)論:現(xiàn)有的證據(jù)表明,采用切開復(fù)位鋼板內(nèi)固定是治療橈骨遠(yuǎn)端骨折的優(yōu)選手術(shù)方法,能夠改善腕關(guān)節(jié)活動(dòng)度,獲得良好的臨床療效,而切開復(fù)位鋼板內(nèi)固定聯(lián)合腕關(guān)節(jié)鏡技術(shù)、局部植骨等手術(shù)方法在一定程度上能夠減少切開復(fù)位鋼板內(nèi)固定的并發(fā)癥。
Abstract:
Objective:To systematically review the clinical outcomes and safety of different surgical procedures in treatment of distal radius fractures(DRFs).Methods:All the randomized controlled trial(RCT)articles about surgical procedures for treatment of DRFs included from database's inception to June 1,2024 were retrieved from the China National Knowledge Infrastructure,Vip Database,Wanfang Database,Chinese Biomedical Literature Service System,PubMed,Embase,Cochrane Library,and Web of Science through computer.The patients in experiment group and control group were all treated with surgical procedures.The eligible articles were screened according to the retrieval and screening scheme.The information was extracted and the methodological quality of the included researches in the articles was evaluated independently by two researchers.After that,the reticulated plots were drawn by using Stata15.0 software,and a reticulated Meta-analysis on excellent and good rate of efficacy,complication incidence rate,as well as wrist range of motions(ROMs)including radial devi-ation,ulnar deviation,palmar flexion,dorsal expansion,pronation and supination was conducted,furthermore,the efficacies of the adopted surgical methods were ranked according to the surface under the cumulative ranking curve(SUCRA),and the publication bias was tested by using a comparison-correction funnel plot.Results:Ten thousand three hundred and twenty articles were searched out.After screening,34 articles were included in the final analysis,involving open reduction(OR)and plate internal fixation,closed reduction(CR)and frame external fixation,CR and Kirschner wire(K-wire)internal fixation,CR and intramedullary nail(IMN)internal fixation,wrist arthroscopic technique(WAT)combined with OR and plate internal fixation,as well as OR and plate internal fixation combined with local bone grafting(LBG).The results of reticulated Meta-analysis revealed that,in treatment of DRFs,the WAT combined with OR and plate internal fixation(SUCRA=99.90%)behaved best in the excellent and good rate of efficacy,followed by OR and plate internal fixation(SUCRA=49.80%),CR and frame external fixation(SUCRA=41.50%),and CR and K-wire internal fixation(SUCRA=8.80%); the WAT combined with OR and plate internal fixation(SUCRA=85.10%)behaved best in wrist ROM of radial deviation,followed by CR and K-wire internal fixation(SUCRA=84.70%),CR and IMN internal fixation(SUCRA=41.90%),OR and plate internal fixation(SUCRA=36.20%),and CR and frame external fixation(SUCRA=2.00%); the OR and plate internal fixation(SUCRA=86.90%)behaved best in wrist ROM of ulnar deviation,followed by CR and IMN internal fixation(SUCRA=67.90%),CR and K-wire internal fixation(SUCRA=43.50%),CR and frame external fixation(SUCRA=36.90%),and WAT combined with OR and plate internal fixation(SUCRA=14.70%); the WAT combined with OR and plate internal fixation(SUCRA=87.10%)behaved best in wrist ROM of palmar flexion,followed by CR and IMN internal fixation(SUCRA=65.90%),CR and K-wire internal fixation(SUCRA=62.30%),OR and plate internal fixation(SUCRA=34.00%),and CR and frame external fixation(SUCRA=0.70%); the OR and plate internal fixation(SUCRA=90.80%)behaved best in wrist ROM of dorsal expansion,followed by CR and IMN internal fixation(SUCRA=69.40%),CR and K-wire internal fixation(SUCRA=33.90%),CR and frame external fixation(SUCRA=32.90%),and WAT combined with OR and plate internal fixation(SUCRA=23.10%); the OR and plate internal fixation(SUCRA=93.50%)behaved best in wrist ROM of pronation,followed by CR and IMN internal fixation(SUCRA=59.00%),CR and frame external fixation(SUCRA=41.30%),CR and K-wire internal fixation(SUCRA=32.50%),and WAT combined with OR and plate internal fixation(SUCRA=23.80%); the OR and plate internal fixation(SUCRA=89.80%)behaved best in wrist ROM of supination,followed by CR and frame external fixation(SUCRA=55.80%),CR and IMN internal fixation(SUCRA=54.80%),CR and K-wire internal fixation(SUCRA=27.60%),and WAT combined with OR and plate internal fixation(SUCRA=22.00%); the OR and plate internal fixation combined with LBG(SUCRA=85.70%)behaved best in complication incidence rate,followed by WAT combined with OR and plate internal fixation(SUCRA=71.40%),CR and IMN internal fixation(SUCRA=58.30%),CR and K-wire internal fixation(SUCRA=47.30%),OR and plate internal fixation(SUCRA=25.00%),and CR and frame external fixation(SUCRA=12.30%).Conclusion:Available evidences suggest that,the OR and plate internal fixation behaves best in treating DRFs,and it can improve the wrist ROM and achieve better clinical outcomes; while,the OR and plate internal fixation combined with WAT or LBG can reduce the complications resulting from OR and plate internal fixation to some extent.

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基金項(xiàng)目:河北省醫(yī)學(xué)科學(xué)研究課題(20240655)
通訊作者:李國(guó)梁 E-mail:[email protected]
更新日期/Last Update: 1900-01-01