摘要
目的:比较掌侧入路与背侧入路加压螺钉固定治疗腕舟骨骨折的疗效与安全性。方法:应用计算机检索PubMed、Embase、The Cochrane Library、中国知网、维普网、中国生物医学文献数据库和万方数据库中关于掌侧入路与背侧入路加压螺钉固定治疗腕舟骨骨折对比研究的文献,检索时限为建库至2020年10月。依据文献检索及筛选方案筛选出符合要求的文献后,由2名研究人员分别独立进行数据提取和质量评价。采用RevMan5.3软件进行Meta分析。结果:共检索到316篇文献,最终纳入17篇文献,共涉及872例患者。Meta分析结果显示,掌侧入路组和背侧入路组手术时间和腕关节掌屈、背伸、桡偏、尺偏活动度及Mayo腕关节评分的组间差异均无统计学意义[I^(2)=60%,MD=2.37,95%CI(-0.13,4.88),P=0.060;I^(2)=40%,SMD=0.10,95%CI(-0.15,0.34),P=0.440;I^(2)=18%,SMD=-0.02,95%CI(-0.26,0.23),P=0.880;I^(2)=48%,SMD=-0.06,95%CI(-0.31,0.18),P=0.610;I^(2)=26%,SMD=0.17,95%CI(-0.08,0.41),P=0.180;I^(2)=0%,MD=-0.15,95%CI(-1.44,1.13),P=0.820];掌侧入路组术中出血量少于背侧入路组[I^(2)=95%,MD=-4.63,95%CI(-8.64,-0.62),P=0.020],骨折愈合时间短于背侧入路组[I^(2)=92%,MD=-2.42,95%CI(-4.19,-0.65),P=0.007],综合疗效优良率高于背侧入路组[I^(2)=0%,OR=2.64,95%CI(1.50,4.67),P=0.001],骨折不愈合率及其他并发症发生率均低于背侧入路组[I^(2)=18%,OR=0.41,95%CI(0.19,0.91),P=0.030;I^(2)=0%,OR=0.48,95%CI(0.28,0.82),P=0.007]。结论:现有的证据表明,掌侧入路与背侧入路加压螺钉固定治疗腕舟骨骨折,在手术时间、腕关节功能恢复方面无明显差异,但掌侧入路加压螺钉固定比背侧入路加压螺钉固定术中出血少、骨折愈合快、综合疗效好、并发症发生率低。
Objective:To compare the clinical efficacy and safety of compression screw fixation through volar approach(VA)versus dorsal approach(DA)in treatment of scaphoid fractures.Methods:All the randomized controlled trial(RCT)and non-RCT articles about compression screw fixation through VA(VA group)versus DA(DA group)for treatment of scaphoid fractures included from database establishing to October 2020 were retrieved from PubMed, Embase, The Cochrane Library, China National Knowledge Internet, Vip Database, Chinese Biomedical Literature Database and WanFang Database through computer.The articles were screened and the information was extracted independently by two researchers according to the retrieval and screening scheme.The methodological quality of research in the articles was evaluated independently by the same two researchers and a Meta-analysis was conducted by using RevMan5.3 software.Results:Three hundred and sixteen articles were searched out.After screening, 17 articles(872 patients)were included in the final analysis.The results of Meta-analysis revealed that there was no statistical difference in operative time, range of motion of wrist(palmar flexion, dorsal expansion, radial deviation and ulnar deviation)and Mayo wrist scores between VA group and DA group(I^(2)=60%,MD=2.37,95%CI(-0.13,4.88),P=0.060;I^(2)=40%,SMD=0.10,95%CI(-0.15,0.34),P=0.440;I^(2)=18%,SMD=-0.02,95%CI(-0.26,0.23),P=0. 880;I2= 48%,SMD =-0. 06,95% CI(-0. 31,0. 18),P = 0. 610;I^(2)= 26%,SMD = 0. 17,95% CI(-0. 08,0. 41),P = 0. 180;I2=0%,MD =-0. 15,95% CI(-1. 44,1. 13),P = 0. 820). The intraoperative blood loss was less,fracture healing time was shorter,excellent rate of comprehensive curative effect was higher,and fracture nonunion rate as well as other complication incidence were lower in VA group compared to DA group( I2= 95%,MD =-4. 63,95% CI(-8. 64,-0. 62),P = 0. 020;I^(2)= 92%,MD =-2. 42,95% CI(-4. 19,-0. 65),P = 0. 007;I^(2)= 0%,OR = 2. 64,95% CI( 1. 50,4. 67),P = 0. 001;I^(2)= 18%,OR = 0. 41,95% CI( 0. 19,0. 91),P = 0. 030;I^(2)=0%,OR = 0. 48,95% CI( 0. 28,0. 82),P = 0. 007). Conclusion: Available evidences suggest that there is no obvious difference in operative time and wrist function recovery between VA and DA in compression screw fixation for treatment of scaphoid fractures,however,the former has such advantages as less intraoperative blood loss,faster fracture healing,better comprehensive curative effects and lower complication incidence compared to the latter.
作者
卢承印
石淇允
张来福
王孝辉
LU Chengyin;SHI Qiyun;ZHANG Laifu;WANG Xiaohui(Henan University of Chinese Medicine,Zhengzhou 450046,Henan,China;Hunan University of Chinese Medicine,Changsha 410208,Hunan,China;Luoyang Orthopedic-Traumatological Hospital,Luoyang 471002,Henan,China)
出处
《中医正骨》
2021年第6期42-48,共7页
The Journal of Traditional Chinese Orthopedics and Traumatology
关键词
舟骨
腕损伤
骨折
手术入路
META分析
scaphoid bone
wrist injuries
fractures,bone
operative approach
meta-analysis
