UNASSIGNED:本系统综述和荟萃分析的目的是评估掌侧锁定钢板(VLP)内固定在治疗桡骨远端骨折(DRF)方面是否比闭合复位和固定石膏能带来更好的临床和放射学结果。
UNASSIGNED:在PubMed中进行了全面的文献检索,WebofScience,和Cochrane数据库截至2022年1月。纳入标准包括随机对照试验(RCT)研究,比较VLP固定和石膏固定的DRF。调查参数为患者评分腕部评估问卷,残疾的伤害,肩膀,和手得分(DASH),运动范围(ROM),握力,生活质量(QoL),放射学结果,并发症和再手术率,短期和中期/长期随访。使用Downs和Black的“质量测量清单”评估偏倚风险和证据质量。
未经授权:共纳入12个RCTs(1368名患者)。ROM没有发现差异,握力,QoL,再操作,而VLP组3个月时的DASH改善有统计学意义(P<0.05)。在较长的随访中没有证实临床差异。从放射学的角度来看,仅在>3个月时的径向倾斜度(4°)和尺骨方差(平均差1.1mm)对VLP组具有统计学意义(均P<0.05)。VLP组并发症较少(P<0.05)。但它们并没有导致不同的再干预率。
UASSIGNED:这项荟萃分析表明,手术方法在最初几个月内可带来更好的临床结果,更好的骨折对齐,并发症发生率较低。然而,3个月后临床结局无差异.总的来说,这些发现表明,对于功能需求较高的人,需要更快的恢复,虽然他们支持在要求较低的患者中采用更保守的方法的好处。
UNASSIGNED: The aim of this systematic
review and meta-analysis was to evaluate whether volar locking plate (VLP) fixation leads to better clinical and radiological outcomes than those of closed reduction and cast immobilization for the treatment of distal radius fractures (DRFs).
UNASSIGNED: A comprehensive literature search was performed in PubMed, Web of Science, and Cochrane databases up to January 2022. Inclusion criteria included randomized controlled trial (RCT) studies comparing VLP fixation with cast immobilization for DRFs. Investigated parameters were Patient-Rated Wrist Evaluation questionnaire, Disabilities of the Harm, Shoulder, and Hand score (DASH), range of motion (ROM), grip strength, quality of life (QoL), radiological outcome, and complication and reoperation rate, both at short- and mid-/long-term follow-up. Assessment of risk of bias and quality of evidence was performed with Downs and Black\'s \'Checklist for Measuring Quality\'.
UNASSIGNED: A total of 12 RCTs (1368 patients) were included. No difference was found for ROM, grip strength, QoL, and reoperation, while the DASH at 3 months was statistically better in the VLP group (P < 0.05). No clinical differences were confirmed at longer follow-up. From a radiological perspective, only radial inclination (4°) and ulnar variance (mean difference 1.1 mm) at >3 months reached statistical significance in favor of the VLP group (both P < 0.05). Fewer complications were found in the VLP group (P < 0.05), but they did not result in different reintervention rates.
UNASSIGNED: This meta-analysis showed that the surgical approach leads to a better clinical outcome in the first months, better fracture alignment, and lower complication rate. However, no differences in the clinical outcomes have been confirmed after 3 months. Overall, these findings suggest operative treatment for people with higher functional demand requiring a faster recovery, while they support the benefit of a more conservative approach in less demanding patients.