中国组织工程研究

中国组织工程研究 ›› 2016, Vol. 20 ›› Issue (9): 1361-1368.doi: 10.3969/j.issn.2095-4344.2016.09.021

• 骨与关节循证医学 evidence-based medicine of the bone and joint • 上一篇    

克氏针与钢板置入内固定修复老年桡骨远端骨折安全及有效性的Meta分析

王 松1，刘孟军1，杨青山2，杜 斌3，林 清4，位新维1，台会平2，陈志信2   

  1. 1兰州大学第一临床医学院，甘肃省兰州市 730000；2甘肃省人民医院，甘肃省兰州市 730000；3西安市第九医院，陕西省西安市 710054；4福清市医院，福建省福清市 350313
  • 收稿日期:2016-01-04 出版日期:2016-02-19 发布日期:2016-02-19
  • 通讯作者: 陈志信，博士，主任医师，甘肃省人民医院骨一科，甘肃省兰州市 730000
  • 作者简介:王松，男，1988年生，湖北省利川市人，土家族，2016年兰州大学毕业，硕士，主要从事创伤骨科方面的研究。

Safety and effectiveness of Kirschner wire and plate fixation for treating distal radial fracture in the elderly: a meta-analysis

Wang Song1, Liu Meng-jun1, Yang Qing-shan2, Du Bin3, Lin Qing4, Wei Xin-wei1, Tai Hui-ping2, Chen Zhi-xin2   

  1. 1the First Clinical Medical College of Lanzhou University, Lanzhou 730000, Gansu Province, China; 2the People’s Hospital of Gansu Province, Lanzhou 730000, Gansu Province, China; 3Xi’an Ninth Hospital, Xi’an 710054, Shaanxi Province, China; 4Fuqing Municipal Hospital, Fuqing 350313, Fujian Province, China
  • Received:2016-01-04 Online:2016-02-19 Published:2016-02-19
  • Contact: Chen Zhi-xin, M.D., Chief physician, the People’s Hospital of Gansu Province, Lanzhou 730000, Gansu Province, China
  • About author:Wang Song, Master, the First Clinical Medical College of Lanzhou University, Lanzhou 730000, Gansu Province, China

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被引次数

21

摘要：

文章快速阅读：

文题释义：

克氏针：克氏针通过皮肤使两骨折端连接，具有简单，快捷，微创，花费少，对手术器械要求少等优点。但克氏针的柔韧性导致手术后需给予石膏外固定6周左右，或者直到拔出克氏针；另外克氏针需要穿过皮肤，可增高感染的概率。
钢板置入：钢板置入内固定可以在直视下对骨折进行复位，固定更为牢固，可以减少关节僵硬。钢板和螺钉在体内存在时间长，骨折移位的可能性相对较克氏针少。然而钢板置入内固定的手术时间较克氏针长，可能会产生神经血管损伤等的并发症以及肌腱损伤。

 

背景：桡骨远端骨折的修复方法较多，克氏针与钢板置入内固定都是常见的修复方法，临床医生在固定方式的选择上存在较大灵活性，但目前国内外尚未见两者对桡骨远端骨折修复效果的比较。
目的：系统评价克氏针与钢板置入内固定修复老年桡骨远端骨折安全及有效性的差异。
方法：用循证医学的方法检索CBM、CNKI、VIP、PubMed、Cochrane Library等数据库，并手工检索《中华骨科杂志》、《中华创伤骨科杂志》、《中华创伤杂志》、《实用骨科杂志》等。严格按照文献纳入、排除标准筛选文献，对纳入文献按照Cochrane手册评价方法进行质量评价，对符合标准的文献进行数据提取，利用RevMan 5.2进行数据合并分析。

结果与结论：共纳入9个随机对照试验。Meta分析结果显示，钢板组随访3个月上肢功能评分[MD= -4.55(-7.89，-1.21)，P=0.008]、随访12个月上肢功能评分[MD=-3.13(-6.08，-0.18)，P=0.004]均优于克氏针组，钢板组感染发生率低于克氏针组[OR=0.42(0.23，0.79)，P=0.007]。复杂性局部痛综合征发生率[OR= 0.28(0.05，1.38)，P=0.12]、腕管综合征发生率[OR=0.75(0.20，2.76)，P=0.66]、肌腱损伤[OR=1.66(0.51，5.41)，P=0.64]方面钢板组及克氏针组差异无显著性意义。提示与克氏针相比，钢板置入内固定在修复老年桡骨远端骨折过程中更为安全有效，在经济情况允许下，建议老年骨质疏松桡骨远端骨折的患者尽量行钢板内固定。 

ORCID: 0000-0001-7781-5927(陈志信)

关键词: 骨科植入物, 骨植入物, 钢板, 克氏针, 桡骨远端骨折, Meta分析, 随机对照试验

Abstract:

BACKGROUND: There are many ways for surgical treatment of distal radius fractures. Both volar locking plates and Kirschner wires are common methods. Doctors have considerable flexibility in the choice of the ways of fixation, but both at home and abroad there is no comparison between the effects of the two operations for treating distal radius fractures.
OBJECTIVE: To systematically review the differences in effectiveness and safety of volar locking plates versus Kirschner wires for distal radial fracture.
METHODS: Databases such as CBM, CNKI, VIP, PubMed and Cochrane Library were electronically searched. Chinese Journal of Orthopaedics, Chinese Journal of Orthopaedic Trauma, Chinese Journal of Trauma and Journal of Practical Orthopaedics were searched by hand. In strict accordance with inclusion and exclusion criteria, articles were screened. Methodological quality of included studies was evaluated according to Cochrane Handbook. Data were extracted, and then analyzed with RevMan 5.2 software.
RESULTS AND CONCLUSION: Nine randomized controlled trials were included. Meta-analysis results demonstrated that upper limb function scores were better in the volar locking plate group than in the Kirschner wire group [MD= -4.55(-7.89, -1.21), P=0.008] at 3 months of follow-up and [MD= -3.13(-6.08, -0.18), P=0.004] at 12 months. The incidence of infection was lower in the volar locking plate group than in the Kirschner wire group [OR= 0.42(0.23, 0.79), P=0.007]. No significant difference in incidence of complex regional pain syndrome [OR=0.28(0.05, 1.38), P=0.12], incidence of carpal tunnel syndrome [OR=0.75(0.20, 2.76), P=0.66] and tendon injury [OR= 1.66(0.51, 5.41), P=0.64] was detected between the volar locking plate group and Kirschner wire group. These results indicated that compared with the Kirschner wire, volar locking plate fixation for the repair of distal radial fracture is safe and effective. In the permission of economic circumstances, it is suggested that elder osteoporosis patients with distal radial fracture should receive plate fixation.