掌侧锁定钢板与闭合复位固定治疗老年人桡骨远端骨折:随机对照试验的系统回顾和荟萃分析

Pub Date : 2023-11-07 DOI:10.1055/s-0043-1774331
Niyaz Latypov, Igor Golubev, Alyona Borisova
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引用次数: 0

摘要

摘要:本文对年龄≥60岁的急性桡骨远端移位性骨折老年患者进行了系统回顾和随机对照试验的荟萃分析,比较了开放复位内固定(ORIF)联合掌侧锁定钢板(VLP)与封闭复位固定保守治疗。方法检索MEDLINE、Scopus和Central Register of Controlled Trials (Central)数据库。12个月的临床和影像学指标通过汇总平均差异进行组间比较。通过合并相对风险比比较并发症发生率。将手臂、肩部和手部残疾(DASH)和患者评定腕关节评估(PRWE)结果的汇总平均差异与已发表的最小临床重要差异(MCID)进行比较,以评估结果的临床相关性。结果初步检索得到766条记录,从中选择6篇文章进行最终分析。随访12个月时,手术治疗组DASH问卷结果显著低于手术治疗组,平均差值(MD)为-3.61点(95%可信区间[CI]: -6.48 ~ -0.73)。PRWE问卷的差异无统计学意义(MD = -3.14分[95% CI: -7.32 ~ 1.04])。手术治疗组放射学结果明显优于手术治疗组,两组总并发症发生率无显著差异。发现DASH和PRWE的MD未达到已公布的MCIDs。结论本研究表明,对于年龄≥60岁的急性移位性桡骨远端骨折的老年患者,在12个月的随访中,与保守治疗闭合复位和固定相比,ORIF联合VLP手术治疗并没有提供临床相关的益处,尽管放射学结果更好。
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Volar Locking Plate versus Closed Reduction and Immobilization for Distal Radius Fracture in the Elderly: Systematic Review and Meta-Analysis of Randomized Controlled Trials
Abstract Introduction A systematic review and meta-analysis of randomized controlled trials was conducted to compare surgical treatment using open reduction and internal fixation (ORIF) with volar locking plates (VLP) to conservative treatment with closed reduction and immobilization in elderly patients aged ≥60 years with acute displaced distal radius fractures. Methods A search of the MEDLINE, Scopus, and Central Register of Controlled Trials (CENTRAL) databases was conducted. Clinical and radiographic measures at 12 months were compared between groups by pooling the mean difference. The complication rates were compared by pooling relative risk ratios. Pooled mean differences of Disabilities of the Arm, Shoulder, and Hand (DASH) and Patient-Rated Wrist Evaluation (PRWE) results were compared with the published minimal clinically important difference (MCID) to evaluate the clinical relevance of the results. Results The initial search yielded 766 records, from which 6 articles were selected for the final analysis. The results of the DASH questionnaire at 12 months of follow-up were significantly lower in the surgical treatment group with a mean difference (MD) of –3.61 points (95% confidence interval [CI]: –6.48 to –0.73). No statistically significant difference was found in the PRWE questionnaire (MD = –3.14 points [95% CI: –7.32 to 1.04]). Radiological results were significantly better in the surgical treatment group and no significant difference in the overall complication rate between the groups was detected. Found MD for DASH and PRWE did not reach the published MCIDs. Conclusion This study suggests that for elderly patients aged ≥60 years with acute displaced distal radius fractures, surgical treatment using ORIF with VLP does not provide clinically relevant benefits compared with conservative treatment with closed reduction and immobilization at the 12-month follow-up, despite demonstrating better radiological results.
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