中医正骨2025，Vol.37Issue(1)：9-19,25,12.
不同手术方法治疗桡骨远端骨折临床疗效和安全性的网状Meta分析
Clinical efficacy and safety of different surgical procedures in treatment of distal radius fractures:a network meta-analysis
摘要
Abstract
Objective:To systematically review the clinical outcomes and safety of different surgical procedures in treatment of distal radius fractures(DRFs).Methods:All the randomized controlled trial(RCT)articles about surgical procedures for treatment of DRFs in-cluded from database's inception to June 1,2024 were retrieved from the China National Knowledge Infrastructure,Vip Database,Wanfang Database,Chinese Biomedical Literature Service System,PubMed,Embase,Cochrane Library,and Web of Science through computer.The patients in experiment group and control group were all treated with surgical procedures.The eligible articles were screened according to the retrieval and screening scheme.The information was extracted and the methodological quality of the included researches in the articles was evaluated independently by two researchers.After that,the reticulated plots were drawn by using Stata15.0 software,and a reticulated Meta-analysis on excellent and good rate of efficacy,complication incidence rate,as well as wrist range of motions(ROMs)including radial devi-ation,ulnar deviation,palmar flexion,dorsal expansion,pronation and supination was conducted,furthermore,the efficacies of the adopted surgical methods were ranked according to the surface under the cumulative ranking curve(SUCRA),and the publication bias was tested by using a comparison-correction funnel plot.Results:Ten thousand three hundred and twenty articles were searched out.After screening,34 articles were included in the final analysis,involving open reduction(OR)and plate internal fixation,closed reduction(CR)and frame ex-ternal fixation,CR and Kirschner wire(K-wire)internal fixation,CR and intramedullary nail(IMN)internal fixation,wrist arthroscopic tech-nique(WAT)combined with OR and plate internal fixation,as well as OR and plate internal fixation combined with local bone grafting(LBG).The results of reticulated Meta-analysis revealed that,in treatment of DRFs,the WAT combined with OR and plate internal fixation(SUCRA=99.90％)behaved best in the excellent and good rate of efficacy,followed by OR and plate internal fixation(SUCRA=49.80％),CR and frame external fixation(SUCRA=41.50％),and CR and K-wire internal fixation(SUCRA=8.80％);the WAT com-bined with OR and plate internal fixation(SUCRA=85.10％)behaved best in wrist ROM of radial deviation,followed by CR and K-wire in-ternal fixation(SUCRA=84.70％),CR and IMN internal fixation(SUCRA=41.90％),OR and plate internal fixation(SUCRA=36.20％),and CR and frame external fixation(SUCRA=2.00％);the OR and plate internal fixation(SUCRA=86.90％)behaved best in wrist ROM of ulnar deviation,followed by CR and IMN internal fixation(SUCRA=67.90％),CR and K-wire internal fixation(SUCRA=43.50％),CR and frame external fixation(SUCRA=36.90％),and WAT combined with OR and plate internal fixation(SUCRA=14.70％);the WAT combined with OR and plate internal fixation(SUCRA=87.10％)behaved best in wrist ROM of palmar flexion,fol-lowed by CR and IMN internal fixation(SUCRA=65.90％),CR and K-wire internal fixation(SUCRA=62.30％),OR and plate internal fixation(SUCRA=34.00％),and CR and frame external fixation(SUCRA=0.70％);the OR and plate internal fixation(SUCRA=90.80％)behaved best in wrist ROM of dorsal expansion,followed by CR and IMN internal fixation(SUCRA=69.40％),CR and K-wire internal fixation(SUCRA=33.90％),CR and frame external fixation(SUCRA=32.90％),and WAT combined with OR and plate internal fixation(SUCRA=23.10％);the OR and plate internal fixation(SUCRA=93.50％)behaved best in wrist ROM of pronation,followed by CR and IMN internal fixation(SUCRA=59.00％),CR and frame external fixation(SUCRA=41.30％),CR and K-wire internal fixation(SUCRA=32.50％),and WAT combined with OR and plate internal fixation(SUCRA=23.80％);the OR and plate internal fixation(SUCRA=89.80％)behaved best in wrist ROM of supination,followed by CR and frame external fixation(SUCRA=55.80％),CR and IMN internal fixation(SUCRA=54.80％),CR and K-wire internal fixation(SUCRA=27.60％),and WAT combined with OR and plate internal fixation(SUCRA=22.00％);the OR and plate internal fixation combined with LBG(SUCRA=85.70％)behaved best in compli-cation incidence rate,followed by WAT combined with OR and plate internal fixation(SUCRA=71.40％),CR and IMN internal fixation(SUCRA=58.30％),CR and K-wire internal fixation(SUCRA=47.30％),OR and plate internal fixation(SUCRA=25.00％),and CR and frame external fixation(SUCRA=12.30％).Conclusion:Available evidences suggest that.the OR and plate internal fixation behaves best in treating DRFs,and it can improve the wrist ROM and achieve better clinical outcomes;while,the OR and plate internal fixation com-bined with WAT or LBG can reduce the complications resulting from OR and plate internal fixation to some extent.关键词
桡骨骨折/骨折闭合复位/骨折切开复位/骨折固定术,内/伊利扎罗夫技术/网络Meta分析Key words
radius fractures/closed fracture reduction/open fracture reduction/fracture fixation,internal/Ilizarov technique/network meta-analysis引用本文复制引用
吕德梁,李国梁,赵建勇,王鑫,袁野,王铁强,王旭洋,刘文东,沈润斌..不同手术方法治疗桡骨远端骨折临床疗效和安全性的网状Meta分析[J].中医正骨,2025,37(1):9-19,25,12.基金项目
河北省医学科学研究课题(20240655) （20240655）
