目的:本研究的目的是分析固定类型是否存在任何差异(肘部上方与肘部以下)在成人桡骨远端骨折的保守治疗中。
方法:本研究按照系统评价和Meta分析的优选报告项目进行。截至2021年10月1日,在Medline进行了电子文献检索,Embase,使用搜索词的Ovid和Cochrane数据库,“桡骨远端骨折或桡骨远端骨折”,“保守治疗或非手术治疗”,“肘部固定上方”和“肘部固定下方”。用英语撰写的随机临床试验,通过Cochrane协作,根据偏倚风险评估(RoB2)工具,采用保守或非手术方法对成人桡骨远端骨折的结局进行了描述。非随机临床试验,观察性研究,回顾性研究,评论文章,评论,社论,会议介绍,本综述不包括手术技术和没有全文的文章.荟萃分析使用ReviewManager版本5.4.1(CochraneCollaboration,哥本哈根,丹麦)。
结果:纳入6项随机临床试验进行定量审查。在所有研究中都注意到高度异质性(I2>75%)。手臂残疾的标准平均差,两组的肩和手评分均为0.52(95%CI(-0.28)-1.32),统计学上无显著性.径向高度无统计学差异(平均差0.10,95%CI(-0.91)-1.12),径向倾角(平均差0.5,95%CI(-1.88)-2.87),手掌倾斜(平均差1.06,95%CI(-0.31)-2.43)和尺骨方差(平均差0.05,95%CI(-0.74)-0.64)。观察到,肩痛在肘部固定以上的并发症中更常见,并且该值具有统计学意义(肘部以上:38/92,41.3%;肘部以下:19/94,20.2%)。
结论:这项用于保守治疗成人桡骨远端骨折的肘部上方或肘部下方固定的双臂系统评价结果两组在功能和放射学评分方面没有显着差异,但肘部上方组的并发症发生率显着增加。
OBJECTIVE: The aim of this study was to analyze if any difference exists on the type of immobilisation (above elbow vs. below elbow) in the conservative treatment of distal end radius fractures in adults.
METHODS: The study was performed in accordance with Preferred Reporting Items for Systematic Reviews and Meta-analyses. An electronic literature search was performed up to 1st October 2021 in Medline, Embase, Ovid and Cochrane database using the search terms, \"distal end radius fractures OR fracture of distal radius\", \"conservative treatment OR non-surgical treatment\", \"above elbow immobilisation\" and \"below elbow immobilisation\". Randomized clinical trials written in English, describing outcome of distal end radius fractures in adults by conservative or non-surgical means using above elbow immobilisation or below elbow immobilisation were included and assessed according to the risk of bias assessment (RoB2) tool by Cochrane collaboration. Non-randomized clinical trials, observational studies, retrospective studies,
review articles, commentaries, editorials, conference presentations, operative techniques and articles without availability of full text were excluded from this
review. The meta-analysis was performed using
Review Manager version 5.4.1 (The Cochrane Collaboration, Copenhagen, Denmark).
RESULTS: Six randomized clinical trials were included for quantitative
review. High heterogeneity (I2 > 75%) was noted among all the studies. The standard mean difference (MD) between the disability of the arm, shoulder and hand scores in both the groups was 0.52 (95% CI: -0.28 to 1.32) which was statistically non-significant. There was no statistical difference in the radial height (MD = 0.10, 95% CI: -0.91 to 1.12), radial inclination (MD = 0.5, 95% CI: -1.88 to 2.87, palmar tilt (MD =1.06, 95% CI: -0.31 to 2.43) and ulnar variance (MD = 0.05, 95% CI: -0.74 to 0.64). It was observed that shoulder pain occurred more commonly as a complication in above elbow immobilisation and the values were statistically significant (above elbow: 38/92, 41.3%; below elbow: 19/94, 20.2%).
CONCLUSIONS: This two-armed systematic
review on the above elbow or below elbow immobilisation to be used for conservative treatment of the distal end radius fracture in adults resulted in non-significant differences in terms of functional and radiological scores among the 2 groups but significant increase in the complication rates in the above elbow group.