【摘要】 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。更多还原

【Abstract】 Objective To evaluate the effectiveness and safety of external xation(EF) and open reduction and internal xation(ORIF) for unstable distal radius fractures in adults.Methods We searched MEDLINE(1966 to Sep-tember 2008),Cochrane Central register of controlled Trials(The Cochrane Library,Issue 3,2008),EMbase(1974 to Sep-tember 2008),CBM,CNKI,and collected randomized controlled trials(RCTs) of EF and ORIF for unstable distal radius fractures in adults.The quality of the included studies was critically assessed and data analyses were performed with the Cochrane Collaboration’s RevMan 5.0 software.Results Seven RCTs involving 634 patients were included,of which 269 were in EF group,and 293 were in ORIF group.Only 1 study had relative high quality,all the others had some limitation in randomization,blinding,and allocation concealment.The results of meta-analyses showed that,1) about the effective-ness: according to the Gartland and Werley grade standard,the ORIF group was better than the EF group with statistic difference(RR=1.50,95%CI 1.11 to 2.03,P=0.008);because of the original studies did not offer the detailed data including pad strength,grip strength,exion-extension,radial deviation,and ulnar deviation,we only processed a descriptive analy-sis;and 2) about complications: the infection rate of the pin track was higher in the EF group than that in the ORIF group with statistic difference(RR=0.24,95%CI 0.08 to 0.76,P=0.02);but there were no differences between the two groups in reffex sympathetic dystrophy(RSD)(RR=0.88,95%CI 0.30 to 2.56,P=0.82),extensor tendon rupture(RR=3.93,95%CI 0.45 to 34.62,P=0.22),and compartment syndrome(RR=3.13,95%CI 0.51 to 19.09,P=0.22).Conclusions Compared with EF,ORIF is much better based on Gartland and Werley grade standard,and causes much less infection.Because of the limited quality and quantity of the included studies,more proofs are required from more RCTs with large sample.更多还原