【文献】OrthoEvidence:相比管型石膏固定,患者更喜欢夹板治疗桡骨远端buckle骨折
来源：OE
OrthoEvidence 简称OE，其文章特点：
60家顶尖骨科期刊的总结，提炼和评价
新颖易读的呈现形式--- ACE报告（Advanced Clinical Evidence）
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引用信息：Pediatr Emerg Care.《儿科急诊医学》。2013年5月；
译文校审：黄添隆（中南大学湘雅二医院骨科）
Synopsis
摘要
94 children with distal radial buckle fractures were randomized to receive immobilization either with splinting or casting, in order to compare patient satisfaction, convenience, and preference with both immobilization techniques, as well as the pain scores.
94名桡骨远端buckle骨折患者被随机分配接受夹板或管型固定，以比较患者满意度、方便性和对两种固定技术的喜好，以及疼痛评分。
Following evaluati over 21 days, results indicated that satisfaction, convenience, and preferences were significantly favoured the splint group. Although pain scores recorded after immobilization were higher in the splint group, this difference between groups did not reach statistical significance.
评价21天后，结果显示满意度、方便性和喜好均显著支持夹板组。尽管夹板组固定后记录的疼痛评分更高，但这一组间差异未达到统计学显著性。
Why was this study needed now?
为什么现在需要开展这项研究？
Distal radial buckle fractures are injuries to the radius that often ensue in children after falling on an outstretched hand. A variety of different treatment methods exist, as these types of fractures are stable and rarely lead to displacement. However, it is unclear what immobilization technique allows for the best healing. It has been suggested that splinting is more effective than casting in regards to patient satisfaction and earlier return to activity, but that pain remains higher. Hence, this study aimed to compare outcomes between casting and splinting in children with distal radial buckle fractures.
儿童摔倒时伸肘手掌着地常常引起桡骨远端buckle骨折，因为骨折本身稳定性高且很少移位，目前固定方式多种多样，但哪种固定方式最佳尚不明确。有研究表明夹板固定后患者虽然疼痛有所加重，但可尽早恢复活动从而满意度更高。因此本研究旨在比较儿童桡骨远端buckle骨折管型和夹板固定的效果。
What was the principal research question?
主要研究问题是什么？
Which immobilization technique - splinting or casting - for the treatment of distal radial buckle fractures provided better outcomes pertaining to pain, parental and patient preference, convenience, and satisfaction, when measured over a 21 day period?
桡骨远端buckle骨折管型或夹板固定治疗21天后，哪种固定方式疼痛反应更轻，患儿及其家长更为接受？
What were the important findings?
重要发现有哪些？
1, 3, and 21 days following the fracture median satisfaction VAS scores were significantly higher for patients in the splint group,in comparison to the cast group (Day 1: p=0.04; Day 3: p=0.004; Day 21: p=0.001). When measured immediately after immobilization and at day 7, no significant differences existed between groups (p>0.05).
与管型组相比，骨折后第1、3和21天，夹板组患者满意度评分明显提高（第1天：p=0.04；第3天：p=0.004；第21天：p=0.001），但固定后即刻以及第7天无明显差异。VAS评分显著高于管型组。固定后即刻以及第7天时测定结果没有显著差异（p>0.05）。
At days 1, 3, 7, and 21 following injury median convenience VAS scores were significantly higher for patients in the splint group, in comparison to the cast group (Day 1: p<0.0001; Day3: p<0.001; Day 7: p<0.001; Day 21:p<0.0001).
与管型组相比，骨折后第1、3、7和21天，夹板组患者方便性评分明显增高（第1天：p<0.0001；第3天：p<0.001；第7天：p<0.001；第21天：p<0.0001）
At days 1, 3, 7, and 21 when asked what immobilization technique patients would prefer to have in the future, there were significantly more patients in the splint group who reported that they would choose the same option (Day 1: p=0.01; Day 3: p=0.002; Day 7: p=0.05; Day21: p=0.004).
骨折后第1、3、7和21天，当被问到以后更愿意使用哪种固定技术时，夹板组报告自己会选择相同技术的患者更多（第1天：p=0.01；第3天：p=0.002；第7天：p=0.05；第21天：p=0.004）。
At baseline median pain scores were significantly higher in the splint group, compared to the cast group (p<0.005). When measured on days 1, 3, 7 and 21, even though median pain scores were numerically higher in the splint group, this difference did not lead to statistical significance (p> 0.05).
夹板组基线中位疼痛评分显著高于管型组（p<0.005）。在第1、3、7和21天测定时，尽管夹板组中位疼痛评分在数字上更大，但是并没有统计学显著性（p>0.05）。
The median amount of time it took to immobilize patients was significantly longer in the cast group, compared to the splint group (10 minutes vs 2 minutes) (p<0.001). After immobilization significantly more patients in the cast group required additional assistance in completing tasks, compared to the splint group (18 patients (36%) vs 1 patient (2%))(p<0.0001).
与管型组相比，夹板组操作时间缩短（10分钟对比2分钟）（p<0.001）。固定后需要额外辅助才能完成特定动作的比例较少（18名患者（36%）对比1名患者（2%））（p<0.0001）。
On day 1 following immobilization, the majority of patients wore their splint. By day 7, 95% of children reported that they removed their splint for some time each day.
夹板组中，固定第1天，大多数患者坚持佩戴夹板。到第7天，95%的儿童报告自己每天会取下夹板一段时间。
There were 4 treatment concerns (9.3%) in the splint group. 2 patients asked for casts within the first 5 days due to pain, 1 patient was advised by an outside physician that all buckle fractures should be casted, and 1 patient received a cast after discovering that he or she had been improperly diagnosed.
夹板组出现4个治疗相关问题（9.3%）。2名患者在前5天内因疼痛而要求管型固定，1名患者接受了一名其他医师建议改为管型固定，，1名患者发现为其他类型骨折改为管型固定。
What should I remember most?
我最应当记住什么？
Results exhibited that satisfaction, convenience, and preference scores were significantly higher for patients who received a splint to treat their distal radial buckle fracture. Although post immobilization pain scores were also higher for the splint group, in comparison to the cast group, this difference was not statistically significant.
对于桡骨远端buckle骨折，夹板固定比管型固定有更好的患者满意度、方便性和偏好，尽管夹板固定疼痛评分稍高，但差异没有统计学意义。
How will this affect the care of patients?
这对患者治疗有何影响？
Patients with nondisplaced distal radial buckle fractures may be treated with splinting over casting, as evidence indicates that splinting leads to significantly higher preference, convenience, and satisfaction scores. Furthermore, according to other studies, splinting appears to be more cost-effective than casting. It should be stressed that this treatment beat the discretion of the treating physician, especially as most children will remove the split by one week for a period of time. Further studies may cider longer-term follow-up.
对于桡骨远端buckle骨折，夹板固定比管型固定有更好的患者满意度、方便性、喜好，同时成本效益更佳。因此推荐采用夹板固定。需要强调的是，考虑到大多数儿童每天会取下夹板一段时间，医生可根据自己经验决定采用何种治疗方式。下一步研究建议长期随访。
How to cite:
引用：
Patients favour splinting over casting for the treatment of distal radial buckle fracture. OrthoEvidence Advanced Clinical Evidence Report. In: Ortho Evidence. Created Jun 10, 2013. Lastmodified Jul 31, 2013. Retrieved Jan 17, 2014 from https://www.myorthoevidence.com:443/?section=15&id=5027.
Why is this study believable? (Risk of Bias)
这项研究为什么可信？（偏倚风险）
1. | Was the allocation sequence adequately generated? 是否随机分组？ | YES 是 |
2. | Was allocation adequately concealed? 随机分组方式是否隐蔽？ | YES 是 |
3. | Blinding Surge: Was knowledge of the allocated interventi adequately prevented? 对手术医生是否施盲？ | NR 无关 |
4. | Blinding Outcome Assessors: Was knowledge of the allocated interventi adequately prevented? 对结果记录者是否施盲？ | NO 否 |
5. | Blinding Patients: Was knowledge of the allocated interventi adequately prevented? 对患者是否施盲？ | NO 否 |
6. | Was loss to follow-up (missing outcome data) infrequent? 失访是否罕见？ | YES 是 |
7. | Are reports of the study free of suggestion of selective outcome reporting? 研究结果是否有选择性报告迹象？ | YES 是 |
8. | Were outcomes objective, patient-important and assessed in a manner to limit bias (ie. duplicate assessors, Independent assessors)? 结果是否客观、以患者为中心并以限制偏倚的方式评估（即两名独立的评估者）？ | YES 是 |
9. | Was the sample size sufficiently large to assure a balance of prognosis and sufficiently large number of outcome events? 样本量大小是否适宜？ | NO 否 |
10. | Was investigator expertise/experience with both treatment and control techniques likely the same (ie.were criteria for surgeon participation/expertise provided)? 相关研究者是否具有施行随机对照研究的相关技能？ | UN 不确定 |
TOTAL SCORE: 5.5/10 总分：5.5/10 YES = 1 | UNCERTAIN = 0.5 | NO = 0 是=1 | 不确定=0.5 | 否=0 | ||
ReportingScore
报告评分
REPORTING QUALITY 报告质量 15/20 |
A）Randomization /4 随机分组 /4 B）Outcome Measurements /4 结果测定 /4 C）Inclusion/Exclusion /4 纳入/排除标准 /4 D）Therapy Description /4 干预措施说明 /4 E）Statistic /4 统计学 /4 |
Therapy Level II - Randomized Trial
循证等级：II– 随机分组试验
校审编辑简介：
黄添隆，主治医师，就职于中南大学湘雅二医院，中国医师协会骨科分会青年委员会委员。
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