[1]王亚洲,陈政权,牛萌煊,等.腕关节镜辅助切开复位内固定术治疗C型桡骨远端骨折疗效和安全性的Meta分析[J].中医正骨,2025,37(11):32-37.
　WANG Yazhou,CHEN Zhengquan,NIU Mengxuan,et al.Efficacy and safety of wrist arthroscopy-assisted surgery of open reduction and internal fixation for treatment of type C distal radius fractures:a meta-analysis[J].The Journal of Traditional Chinese Orthopedics and Traumatology,2025,37(11):32-37.
点击复制

腕关节镜辅助切开复位内固定术治疗C型桡骨远端骨折疗效和安全性的Meta分析()

《中医正骨》[ISSN:1001-6015/CN:41-1162/R]

卷:
第37卷
期数:
2025年11期
页码:
32-37
栏目:
文献研究
出版日期:
2025-11-20

文章信息/Info

Title:
Efficacy and safety of wrist arthroscopy-assisted surgery of open reduction and internal fixation for treatment of type C distal radius fractures:a meta-analysis
作者:
王亚洲1; 陈政权1; 牛萌煊1; 韩鹏飞2; 郭宏斌3
1.长治医学院,山西 长治 046000; 2.长治医学院附属和平医院,山西 长治 046000; 3.长治医学院附属和济医院,山西 长治 046000
Author(s):
WANG Yazhou1; CHEN Zhengquan1; NIU Mengxuan1; HAN Pengfei2; GUO Hongbin3
1.Changzhi Medical College,Changzhi 046000,Shanxi,China 2.Heping Hospital Affiliated to Changzhi Medical College,Changzhi 046000,Shanxi,China 3.Heji Hospital Affiliated to Changzhi Medical College,Changzhi 046000,Shanxi,China
关键词:
桡骨骨折;  腕关节;  关节内骨折;  骨折切开复位;  骨折固定术; 内;  关节镜检查;  专题Meta分析
Keywords:
radius fractures;  wrist joint;  intra-articular fractures;  open fracture reduction;  fracture fixation; internal;  arthroscopy;  meta-analysis as topic
摘要:
目的:系统评价腕关节镜辅助切开复位内固定术治疗C型桡骨远端骨折的疗效和安全性。方法:应用计算机检索中国知网、维普网、万方数据库、中国生物医学文献服务系统、PubMed、Embase、Cochrane Library、Cinahl中关于腕关节镜辅助切开复位内固定术治疗C型桡骨远端骨折的对比研究,检索时限均为建库至2025年2月15日。试验组采用腕关节镜辅助切开复位内固定术治疗,对照组采用传统切开复位内固定术治疗。2名研究人员分别独立进行文献筛选、数据提取和纳入研究的质量评价。采用RevMan5.4软件进行Meta分析。结果:共检索到781篇文献,最终纳入10篇文献。共涉及591例患者,其中试验组280例、对照组311例。Meta分析结果显示,试验组的手术时间长于对照组[MD=18.51,95%CI(3.74,33.29),P=0.010],术中失血量少于对照组[MD=-25.80,95%CI(-42.30,-9.31),P=0.002],握力及腕关节屈曲、背伸活动度均大于对照组[MD=5.37,95%CI(0.47,10.27),P=0.030; MD=6.09,95%CI(0.24,11.95),P=0.040; MD=4.88,95%CI(1.66,8.10),P=0.003],臂、肩和手功能障碍评分及并发症发生率均低于对照组[MD=-4.71,95%CI(-5.33,-4.09),P=0.000; OR=0.36,95%CI(0.20,0.65),P=0.001],骨折愈合时间、患者自评腕关节评分及腕关节旋前、旋后活动度与对照组的差异均无统计学意义[MD=-4.59,95%CI(-9.54,0.36),P=0.070; MD=-2.86,95%CI(-6.15,0.43),P=0.090; MD=3.04,95%CI(-0.04,6.14),P=0.050; MD=3.64,95%CI(-1.87,9.17),P=0.200]。结论:现有证据表明,与传统切开复位内固定术相比,腕关节镜辅助切开复位内固定术治疗C型桡骨远端骨折更有利于减少术中失血量、恢复腕关节功能,且安全性更高。
Abstract:
Objective:To systematically review the therapeutic efficacy and safety of wrist arthroscopy-assisted surgery of open reduction and internal fixation(ORIF)in treatment of type C distal radius fractures.Methods:All the comparative study articles about wrist arthroscopy-assisted ORIF for treatment of type C distal radius fractures included from database's inception to February 15,2025 were retrieved from the China National Knowledge Infrastructure,Vip Database,Wanfang Database,Chinese Biomedical Literature Service System,PubMed,Embase,Cochrane Library,and Cinahl through computer.The patients in experiment group were treated with wrist arthroscopy-assisted ORIF,while the ones in control group with conventional ORIF.The pertinent articles were screened,the information was extracted and the methodological quality of the included researches in the articles was evaluated independently by two researchers,and then a Meta-analysis was conducted by using RevMan5.4 software.Results:Seven hundred and eighty-one articles were searched out.After screening,10 ones(591 patients)were included in the final analysis,with 280 patients in experiment group and 311 ones in control group.The Meta-analysis revealed that,compared to the control group,the experiment group demonstrated a longer operative time,but less intraoperative blood loss(MD=18.51,95%CI(3.74,33.29),P=0.010; MD=-25.80,95%CI(-42.30,-9.31),P=0.002),furthermore,the experiment group exhibited superior outcomes in grip strength,as well as flexion and extension range of motion(ROM)(MD=5.37,95%CI(0.47,10.27),P=0.030; MD=6.09,95%CI(0.24,11.95),P=0.040; MD=4.88,95%CI(1.66,8.10),P=0.003),moreover,the experiment group also had a lower diabilities of the arm,shoulder and hand(DASH)scores and incidence of complications(MD=-4.71,95%CI(-5.33,-4.09),P=0.000; OR=0.36,95%CI(0.20,0.65),P=0.001),while,the fracture healing time,patient-rated wrist evaluation(PRWE)score,or wrist pronation and supination ROM was not significantly different between the 2 groups(MD=-4.59,95%CI(-9.54,0.36),P=0.070; MD=-2.86,95%CI(-6.15,0.43),P=0.090; MD=3.04,95%CI(-0.04,6.14),P=0.050; MD=3.64,95%CI(-1.87,9.17),P=0.200).Conclusion:Available evidences suggest that the wrist arthroscopy-assisted ORIF is superior to the conventional ORIF in reducing intraoperative blood loss and restoring wrist function,with a favorable safety profile,in treatment of type C distal radius fractures.

参考文献/References:

[1] 国家骨科医学中心(北京积水潭医院),中华医学会骨科学分会创新与转化学组,中国康复医学会骨与关节康复专业委员会创伤学组,等.成人桡骨远端骨折诊断与治疗循证指南(2024)[J].骨科临床与研究杂志,2024,9(5):257-274.
[2] 高志强.桡骨远端骨折治疗进展[J].中国医刊,2020,55(7):707-708.
[3] REILAND K,HAASTERT B,AREND W,et al.Epidemiology of distal radius fractures in Germany—incidence rates and trends based on inpatient and outpatient data[J].Osteoporos Int,2024,35(2):317-326.
[4] 中华中医药学会.桡骨远端骨折中西医结合诊疗指南(2024年版)[J].中医正骨,2025,37(1):1-8.
[5] TRUMBLE T E,SCHMITT S R,VEDDER N B.Factors affecting functional outcome of displaced intra-articular distal radius fractures[J].J Hand Surg Am,1994,19(2):325-340.
[6] DANKELMAN L H M,BARVELINK B,VERHOFSTAD M H J,et al.Traditional radiography versus computed tomography to assess reduced distal radius fractures[J].Eur J Trauma Emerg Surg,2024,50(5):2313-2321.
[7] 刘恒山,寿康全,朱高波.改良腕管位透视在掌侧钢板内固定治疗桡骨远端骨折中的应用[J].中国修复重建外科杂志,2024,38(8):976-980.
[8] MEESTERS A M L,TEN DUIS K,KRAEIMA J,et al.The accuracy of gap and step-off measurements in acetabular fracture treatment[J].Sci Rep,2021,11(1):18294.
[9] GABL M,ARORA R,KLAUSER A S,et al.Characteristics of secondary arthrofibrosis after intra-articular distal radius fracture[J].Arch Orthop Trauma Surg,2016,136(8):1181-1188.
[10] 程文静,丁国正,谢家兵,等.桡骨远端骨折掌侧钢板内固定后关节僵硬的危险因素[J].中国组织工程研究,2021,25(27):4374-4378.
[11] RINALDI A,PILLA F,CHIARAMONTE I,et al.Arthroscopic surgery for scaphoid nonunion:a 10-year systematic literature review[J].Musculoskelet Surg,2024,108(2):125-132.
[12] TWEET M L,CALFEE R P,STERN P J.Rotational fluoro-scopy assists in detection of intra-articular screw penetration during volar plating of the distal radius[J].J Hand Surg Am,2010,35(4):619-627.
[13] 蒋协远,王大伟.骨科临床疗效评价标准[M].北京:人民卫生出版社,2005:46-48.
[14] HUDAK P L,AMADIO P C,BOMBARDIER C.Development of an upper extremity outcome measure:the DASH(disabilities of the arm,shoulder and hand)[J].Am J Ind Med,1996,29(6):602-608.
[15] STERNE J A C,SAVOVIC J,PAGE M J,et al.RoB 2:a revised tool for assessing risk of bias in randomised trials[J].BMJ,2019,366:l4898.
[16] STERNE J A,HERN?N M A,REEVES B C,et al.ROBINS-I:a tool for assessing risk of bias in non-randomised studies of interventions[J].BMJ,2016,355:i4919.
[17] 梁都.关节镜结合钢板固定对桡骨远端关节内骨折的影响[J].浙江创伤外科,2020,25(5):841-842.
[18] 王朋涛,卢承印,董家赫,等.腕关节镜辅助治疗老年桡骨远端骨折合并三角纤维软骨复合体损伤[J].实用医学杂志,2022,38(4):405-409.
[19] 方凯彬,王文怀.腕关节镜辅助治疗关节内桡骨远端骨折的早期疗效观察[J].中国修复重建外科杂志,2019,33(2):138-143.
[20] 白成斌,张鹏军,李红斌,等.腕关节镜微创手术对AO-C型桡骨远端骨折患者的疗效观察[J].现代医学与健康研究电子杂志,2022,6(2):35-38.
[21] 周小平,庄家林,刘宗超.腕关节镜辅助切开复位内固定治疗桡骨远端骨折效果[J].中华关节外科杂志电子版,2021,15(2):137-142.
[22] 董傲铮铮,高兴,李文翠,等.腕关节镜辅助复位手术与传统切开复位内固定术对桡骨远端关节面塌陷骨折功能改善的前瞻性随机对照观察[J].骨科临床与研究杂志,2024,9(5):275-281.
[23] SELLES C A,MULDERS M A M,COLARIS J W,et al.Arthroscopic debridement does not enhance surgical treatment of intra-articular distal radius fractures:a randomized controlled trial[J].J Hand Surg Eur Vol,2020,45(4):327-332.
[24] SAAB M,WUNENBURGER P E,GUERRE E,et al.Does arthroscopic assistance improve reduction in distal articular radius fracture?A retrospective comparative study using a blind CT assessment[J].Eur J Orthop Surg Traumatol,2019,29(2):405-411.
[25] YAMAZAKI H,UCHIYAMA S,KOMATSU M,et al.Arthroscopic assistance does not improve the functional or radiographic outcome of unstable intra-articular distal radial fractures treated with a volar locking plate:a randomised controlled trial[J].Bone Joint J,2015,97-B(7):957-962.
[26] VARITIMIDIS S E,BASDEKIS G K,DAILIANA Z H,et al.Treatment of intra-articular fractures of the distal radius:fluoroscopic or arthroscopic reduction?[J].J Bone Joint Surg Br,2008,90(6):778-785.
[27] 刘庆梁,高斌礼.桡骨远端骨折的治疗进展[J].骨科,2019,10(4):363-366.
[28] WOOLNOUGH T,AXELROD D,BOZZO A,et al.What is the relative effectiveness of the various surgical treatment options for distal radius fractures?A systematic review and network meta-analysis of randomized controlled trials[J].Clin Orthop Relat Res,2021,479(2):348-362.
[29] ABE Y,FUJII K.Arthroscopic-assisted reduction of intra-articular distal radius fracture[J].Hand Clin,2017,33(4):659-668.
[30] 武永红.经验多层螺旋CT和X线平片诊断桡骨远端并腕骨骨折的效果对比[J].现代诊断与治疗,2017,28(4):674-676.
[31] 黄吉利,潘捷,赵鸿声.MSCT对不同分型桡骨远端骨折的鉴别及与X线的对照研究[J].中国CT和MRI杂志,2016,14(3):120-123.
[32] 丁海波,陆芸.腕关节镜辅助治疗桡骨远端骨折研究进展[J].中国修复重建外科杂志,2020,34(10):1341-1345.
[33] KASTENBERGER T,KAISER P,SCHMIDLE G,et al.Arthroscopic assisted treatment of distal radius fractures and concomitant injuries[J].Arch Orthop Trauma Surg,2020,140(5):623-638.
[34] SMERAGLIA F,DEL BUONO A,MAFFULLI N.Wrist arthroscopy in the management of articular distal radius fractures[J].Br Med Bull,2016,119(1):157-165.
[35] SHIHAB Z,SIVAKUMAR B,GRAHAM D,et al.Outcomes of arthroscopic-assisted distal radius fracture volar plating:a meta-analysis[J].J Hand Surg Am,2022,47(4):330-340.

相似文献/References:

[1]张容超,徐卫国,万春友,等.手法整复小夹板固定治疗桡骨远端骨折168例[J].中医正骨,2015,27(11):61.
[2]赵萌,陈云丰,周祖忠.切开复位T形钢板联合空心钉内固定治疗 MasonⅢ型桡骨头骨折[J].中医正骨,2015,27(07):58.
[3]刘昕,邓志强,叶家军.撬拨复位弹性髓内钉固定治疗JudetⅣ型儿童桡骨颈骨折[J].中医正骨,2015,27(12):65.
[4]刘欣,刘文刚,吴淮,等.3种方法治疗C型桡骨远端骨折的对比研究[J].中医正骨,2015,27(05):12.
　LIU Xin,LIU Wengang,WU Huai,et al.A comparative study of three methods for treatment of type C distal radius fractures[J].The Journal of Traditional Chinese Orthopedics and Traumatology,2015,27(11):12.
[5]郭世明,石玲玲,郭志民,等.手法复位石膏外固定和切开复位钢板内固定治疗 骨质疏松性桡骨远端骨折的比较研究[J].中医正骨,2015,27(04):15.
　GUO Shiming,SHI Lingling,GUO Zhimin,et al.A comparative study of manual reduction and plaster external fixation versus open reduction and plate internal fixation for treatment of osteoporotic distal radius fractures[J].The Journal of Traditional Chinese Orthopedics and Traumatology,2015,27(11):15.
[6]明晓锋,陈登山,张晓强.闭合复位弹性髓内钉固定和经皮克氏针撬拨复位固定 治疗儿童O'BrienⅡ、Ⅲ型桡骨颈骨折的疗效比较[J].中医正骨,2016,28(02):15.
　MING Xiaofeng,CHEN Dengshan,ZHANG Xiaoqiang.A clinical comparison of closed reduction and internal fixation with elastic intramedullary nails versus percutaneous leverage reduction and internal fixation with Kirschner wire for treatment of O'Brien typeⅡandⅢradial neck fractures in children[J].The Journal of Traditional Chinese Orthopedics and Traumatology,2016,28(11):15.
[7]王仲锋,王晓,李国军,等.骨折三维形态分型在MasonⅡ型桡骨头骨折 Herbert螺钉内固定术中的应用[J].中医正骨,2016,28(03):38.
[8]郑移兵,鲍树仁,齐越峰,等.推压手法复位纸夹板外固定治疗Smith骨折[J].中医正骨,2016,28(03):45.
[9]王国林,高彦平,樊培新.手法复位经皮克氏针内固定硫酸钙填充治疗桡骨远端粉碎性骨折[J].中医正骨,2016,28(03):48.
[10]聂伟志,隋显玉.牵屈复位半管形石膏固定治疗老年Colles骨折[J].中医正骨,2016,28(03):50.
[11]徐善强,陈星,张兴平,等.功能锻炼对桡骨远端骨折拆除石膏外固定后 腕关节康复的影响[J].中医正骨,2015,27(10):58.
[12]周志,刘建,张挺,等.超声引导下闭合复位微创掌侧锁定钢板内固定治疗桡骨远端骨折[J].中医正骨,2019,31(07):48.
[13]王用玉,陈博,许坤,等.口服补肾活血中药治疗老年桡骨远端骨折临床疗效的Meta分析[J].中医正骨,2021,33(09):25.
　WANG Yongyu,CHEN Bo,XU Kun,et al.Clinical efficacy of oral application of Bushen Huoxue(补肾活血)traditional Chinese drugs for treatment of distal radius fractures in the aged:a meta-analysis[J].The Journal of Traditional Chinese Orthopedics and Traumatology,2021,33(11):25.
[14]吕德梁,赵建勇,李国梁,等.数字量化设计辅助闭合穿针复位内固定联合外固定架固定治疗B、C型桡骨远端骨折[J].中医正骨,2024,36(10):76.
[15]李光耀,成永忠,聂伟志,等.闭合穿针固定技术治疗桡骨远端骨折的操作规范[J].中医正骨,2025,37(01):20.
[16]周婷,李多多,喻秋实,等.C型桡骨远端骨折的中西医结合诊疗[J].中医正骨,2025,37(01):26.

备注/Memo

备注/Memo:
通讯作者:郭宏斌 E-mail:1224226856@qq.com
更新日期/Last Update: 1900-01-01