目的:采用Meta分析评价髓内钉与掌侧钢板内固定治疗桡骨远端骨折的临床疗效.方法:计算机检索PubMed、Cochrane Library、Web of science、中国知网(CNKI)、万方数据期刊全文数据库(Wanfang Data)和维普数据库发表的关于髓内钉治疗桡骨远端骨折的随机对照试验(RCTs),检索时间为建库至2016年5月.按照纳入和排除标准独立筛选文献、提取资料,按Cochrane Handbook质量评价标准对文献质量进行评价,采用RevMan 5.2软件进行Meta分析,比较术后握力、临床疗效(屈伸、旋前后和桡尺偏斜)、影像学评估(尺骨变异、桡骨高度、掌倾角、尺偏角)以及术后并发症发生率.结果:共纳入6个随机对照试验,共370例.Meta分析结果示:髓内钉与掌侧钢板内固定组相比较,伸展[MD =5.63,95％ CI(-7.01,18.27),P=0.38],屈曲[MD=3.10,95％CI(-0.67,6.86),P=0.11],旋前[MD =2.58,95％CI(-0.49,5.65),P=0.10],旋后[MD=0.82,95％CI(-1.89,3.54),P=0.55],桡偏[MD=-5.16,95％CI(-14.42,4.11),P=0.28],尺偏[MD=0.19,95％ CI(-2.39,2.77),P=0.88],尺骨变异[MD =-0.01,95％ CI(-0.43,0.42),P=0.97],尺偏角[MD=-0.31,95％CI(-1.37,0.73),P=0.56],桡骨高度[MD =-0.27,95％CI(-0.98,0.44),P=0.45],掌倾角[MD =0.29,95％CI(-0.41,0.99),P=0.42],握力[MD =-1.14,95％ CI(-12.78,10.50),P=0.85]及术后并发症发生率[RR =0.71,95％ CI(0.46,1.09),P=0.12]差异无统计学意义.结论:与掌侧钢板内固定相比,髓内钉治疗桡骨远端骨折的效果相当,不能降低术后并发症的发生,但目前样本量较少,将来应开展大样本量的前瞻性随机对照研究进一步验证髓内钉治疗桡骨远端骨折的临床疗效.%Objective:To evaluate curative effects of intramedullary nail and volar plate internal fixation for distal radius fractures.Methods:The studies concerning about randomized controlled trial of intramedullary nail and volar plate internal fixation for distal radius fractures from create database to May,2016 were searched from PubMed,Cochrane Library,Web of Science,CNKI,Wan Fang data and VIP.Information was screen and taken out according to inclusion and exclusion criteria,quality of literature was evaluated according to Cochrane Handbook evaluating system.Meta analysis was performed by RevMan 5.2 software.Postoperative grip strength,clinical effects(results of flexion and extension,pronation,supination,deflection of ulnar and radialis),imaging evaluation (ulnar variance,radial height,volar tilting angle and radial inclination) and the incidence of postoperative complications were analyzed.Results:Totally 6 RCT including 370 patients were chosen.According to the Meta analysis,there were no statistical differences in extension [MD=5.63,95％CI (-7.01,18.27),P=0.38],flexion [MD =3.10,95％ CI (-0.67,6.86),P=0.11],pronation [MD =2.58,95 ％ CI (-0.49,5.65),P=0.10],supination [MD=0.82,95％CI (-1.89,3.54),P=0.55],radial deviation [MD=-5.16,95％CI (-14.42,4.11),P=0.28],ulnar deviation [MD=0.19,95％CI (-2.39,2.77),P=0.88],ulnar variance [MD=-0.01,95％CI (-0.43,0.42),P=0.97],ulnar inclination [MD=-0.31,95％CI (-1.37,0.73),P=0.56],radial height [MD=0.27,95％CI (-0.98,0.44),P=0.45],radial inclination [MD=0.29,95 ％ CI (-0.41,0.99),P=0.42] and the incidence of postoperative complications [RR=0.71,95％ CI (0.46,1.09),P=0.12] between intramedullary nail and volar plate internal fixation.Conclusion:Compared with volar plate internal fixation,intramedullary nail has the same effect in grip strength,clinical effect,but could not reduce the occurrence of postoperative complications.However,a large number of prospective randomized controlled study should be carried out to prove clinical effect of intramedullary nail for distal radius fractures.
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