Abstract：
OBJECTIVE: This network meta-analysis aims to compare functional outcomes and complications between conservative treatment and surgery for distal radius fractures in patients aged 60 years and over.
METHODS: We searched the PubMed, EMBASE, and Web of Science databases for randomized controlled trials (RCTs) assessing the effect of conservative treatment and surgery for distal radius fractures in patients aged 60 years and over. Primary outcomes included grip strength and overall complications. Secondary outcomes included Disabilities of the Arm, Shoulder, and Hand (DASH) scores, Patient-Rated Wrist Evaluation (PRWE) scores, wrist range of motion and forearm rotation, and radiographic assessment. All continuous outcomes were assessed using standardized mean differences (SMDs) with 95% confidence intervals (CIs), and binary outcomes were assessed using odds ratio (OR) with 95% CIs. The surface under the cumulative ranking curve (SUCRA) was used to determine a hierarchy of treatments. Cluster analysis was performed for grouping treatments based on the SUCRA values of primary outcomes.
RESULTS: Fourteen RCTs were included to compare conservative treatment, volar lockedplate (VLP), K-wires fixation, and external-fixation. VLP outperformed conservative treatment for 1-year and minimum 2-year grip strength (SMD; 0.28 [0.07 to 0.48] and 0.27 [0.02 to 0.53], respectively). VLP yielded the optimal grip strength at 1-year and minimum 2-year follow-up (SUCRA; 89.8% and 86.7%, respectively). In a subgroup analysis of patients aged 60 to 80 years old, VLP outperformed conservative treatment in DASH and PRWE scores (SMD, 0.33 [0.10, 0.56] and 0.23 [0.01, 0.45], respectively). In addition, VLP had the fewest complications (SUCRA = 84.3%). Cluster analysis suggested that VLP and K-wire fixation were more effective treatment groups.
CONCLUSIONS: Evidence to date demonstrates that VLP provides measurable benefits in grip strength and fewer complications to those 60 years of age and over, and that benefit is not reflected in current practice guidelines. There is a subgroup of patients where K-wire fixation outcomes are similar to those of VLP; defining this subgroup may yield substantial societal benefits.
METHODS: We searched the PubMed, EMBASE, and Web of Science databases for randomized controlled trials (RCTs) assessing the effect of conservative treatment and surgery for distal radius fractures in patients aged 60 years and over. Primary outcomes included grip strength and overall complications. Secondary outcomes included Disabilities of the Arm, Shoulder, and Hand (DASH) scores, Patient-Rated Wrist Evaluation (PRWE) scores, wrist range of motion and forearm rotation, and radiographic assessment. All continuous outcomes were assessed using standardized mean differences (SMDs) with 95% confidence intervals (CIs), and binary outcomes were assessed using odds ratio (OR) with 95% CIs. The surface under the cumulative ranking curve (SUCRA) was used to determine a hierarchy of treatments. Cluster analysis was performed for grouping treatments based on the SUCRA values of primary outcomes.
RESULTS: Fourteen RCTs were included to compare conservative treatment, volar lockedplate (VLP), K-wires fixation, and external-fixation. VLP outperformed conservative treatment for 1-year and minimum 2-year grip strength (SMD; 0.28 [0.07 to 0.48] and 0.27 [0.02 to 0.53], respectively). VLP yielded the optimal grip strength at 1-year and minimum 2-year follow-up (SUCRA; 89.8% and 86.7%, respectively). In a subgroup analysis of patients aged 60 to 80 years old, VLP outperformed conservative treatment in DASH and PRWE scores (SMD, 0.33 [0.10, 0.56] and 0.23 [0.01, 0.45], respectively). In addition, VLP had the fewest complications (SUCRA = 84.3%). Cluster analysis suggested that VLP and K-wire fixation were more effective treatment groups.
CONCLUSIONS: Evidence to date demonstrates that VLP provides measurable benefits in grip strength and fewer complications to those 60 years of age and over, and that benefit is not reflected in current practice guidelines. There is a subgroup of patients where K-wire fixation outcomes are similar to those of VLP; defining this subgroup may yield substantial societal benefits.
摘要：
目的：本网络荟萃分析旨在比较60岁及以上桡骨远端骨折患者保守治疗和手术治疗的功能结局和并发症。
方法：我们搜索了PubMed，EMBASE,和WebofScience数据库的随机对照试验（RCT）评估保守治疗和手术对60岁及以上桡骨远端骨折患者的影响。主要结果包括握力和总体并发症。次要结果包括手臂残疾，肩膀,和手（DASH）得分，患者评分腕部评估(PRWE)评分,手腕的运动范围和前臂旋转，和射线照相评估。所有连续结果均使用标准平均差(SMD)和95%置信区间(CI)进行评估。和二元结局使用比值比(OR)和95%CI进行评估。累积排序曲线下的表面(SUCRA)用于确定处理的层次。基于主要结果的SUCRA值对治疗进行分组进行聚类分析。
结果：纳入14个随机对照试验以比较保守治疗，掌侧锁定板(VLP),K线固定,和外固定。VLP在1年和至少2年握力方面优于保守治疗（SMD;0.28[0.07to0.48]和0.27[0.02to0.53]，分别)。VLP在1年和至少2年的随访中产生了最佳的握力（SUCRA;89.8％和86.7％，分别)。在60至80岁患者的亚组分析中，VLP在DASH和PRWE评分方面优于保守治疗(SMD，0.33[0.10,0.56]和0.23[0.01,0.45]，分别)。此外,VLP的并发症最少(SUCRA=84.3%)。聚类分析显示VLP和K线固定是更有效的治疗组。
结论：迄今为止的证据表明，VLP为60岁及以上的人群提供了可测量的握力益处和较少的并发症，这一好处没有反映在当前的实践准则中。有一组患者的克氏针固定结果与VLP相似；定义此亚组可能会产生大量的社会效益。
方法：我们搜索了PubMed，EMBASE,和WebofScience数据库的随机对照试验（RCT）评估保守治疗和手术对60岁及以上桡骨远端骨折患者的影响。主要结果包括握力和总体并发症。次要结果包括手臂残疾，肩膀,和手（DASH）得分，患者评分腕部评估(PRWE)评分,手腕的运动范围和前臂旋转，和射线照相评估。所有连续结果均使用标准平均差(SMD)和95%置信区间(CI)进行评估。和二元结局使用比值比(OR)和95%CI进行评估。累积排序曲线下的表面(SUCRA)用于确定处理的层次。基于主要结果的SUCRA值对治疗进行分组进行聚类分析。
结果：纳入14个随机对照试验以比较保守治疗，掌侧锁定板(VLP),K线固定,和外固定。VLP在1年和至少2年握力方面优于保守治疗（SMD;0.28[0.07to0.48]和0.27[0.02to0.53]，分别)。VLP在1年和至少2年的随访中产生了最佳的握力（SUCRA;89.8％和86.7％，分别)。在60至80岁患者的亚组分析中，VLP在DASH和PRWE评分方面优于保守治疗(SMD，0.33[0.10,0.56]和0.23[0.01,0.45]，分别)。此外,VLP的并发症最少(SUCRA=84.3%)。聚类分析显示VLP和K线固定是更有效的治疗组。
结论：迄今为止的证据表明，VLP为60岁及以上的人群提供了可测量的握力益处和较少的并发症，这一好处没有反映在当前的实践准则中。有一组患者的克氏针固定结果与VLP相似；定义此亚组可能会产生大量的社会效益。
