急性稳定型腕舟骨腰部骨折手术治疗与保守治疗的meta分析  

Meta analysis of surgical and conservative treatment of acute stable scaphoid lumbar fracture

作　　者：徐克钢 薛超 梁开心 史泽恺 李永平[2] XU Kegang;XUE Chao;LIANG Kaixin;SHI Zekai;LI Yongping(The Second Clinical Medical College of Shanxi Medical University1,Taiyuan 030001,China;Department of Orthopaedic,the Second Hospital of Shanxi Medical University2,Taiyuan 030001,China)

机构地区：[1]山西医科大学第二临床医学院,山西太原030001 [2]山西医科大学第二医院骨科,山西太原030001

出　　处：《国际骨科学杂志》2024年第1期68-76,共9页International Journal of Orthopaedics

基　　金：山西省自然科学基金(201801D121079)。

摘　　要：目的 系统评价急性稳定型(无移位或移位<1 mm)腕舟骨腰部骨折手术治疗和保守治疗的疗效。方法 计算机检索以下数据库:PubMed、Cochrane library、 Embase、中国生物医学文献数据库(CBM)、万方数据库、中国期刊全文数据库(CNKI)及维普数据库,检索时间从数据库建立至2023年8月,选取手术治疗与保守治疗急性无移位或移位<1 mm腕舟骨腰部骨折的研究,根据骨折愈合时间、返回工作时间、腕关节活动度、握力、上肢功能障碍(DASH)评分、骨不连率及并发症等结果提取数据,采用Revman5.4进行数据分析,采用stata17.0进行敏感性分析。结果 共纳入15项研究,包括12项随机对照研究和3项病例对照研究,共1 221例患者,其中手术治疗组611例,保守治疗组610例。Meta分析结果显示:与保守治疗组相比,手术治疗组骨折愈合时间更短(P<0.05),返回工作时间更早(P<0.05),腕关节活动度更大(P<0.05),握力更大(P<0.05),骨不连发生率更低(P<0.05)。手术治疗组与保守治疗组DASH评分无显著差异(P>0.05),并发症发生率无显著差异(P>0.05)。结论 手术治疗急性无移位或移位<1 mm腕舟骨腰部骨折较保守治疗获得了更好的握力和腕部活动范围,且骨折愈合时间和重返工作的时间均更短,骨不连发生率更低。两种治疗方法在DASH评分和并发症方面有相似结果。Objective To systematically evaluate the efficacy of surgical and conservative treatment of acute undisplaced or displaced<1 mm scaphoid lumbar fracture.Methods PubMed,Cochrane library,Embase,CBM,Wanfang database,China Journal full-text database(CNKI)and VIP database(from the establishment of the database to August 2023)were searched.Reports of surgical and conservative treatment of acute scaphoid lumbar fracture without displacement or displacement<1 mm were studied.Data were extracted according to the fracture healing time,return to work time,wrist range of motion,grip strength,Disabilities of the Arm,Shoulder and Hand(DASH)score,bone nonunion rate and incidence of complications.Revman 5.4 was used for data analysis,and Stata 17.0 was used for sensitivity analysis.Results A total of 15 studies were included,comprising 12 randomized controlled studies and three case-control studies,involving a total of 1221 patients,consisting of a surgical treatment group(n=611)and a conservative treatment group(n=610).Compared with the conservative treatment group,the surgical group had shorter fracture healing time(P<0.05),earlier return to work(P<0.05),greater wrist range of motion(P<0.05)and greater grip strength(P<0.05).The incidence of nonunion was lower(P<0.05).There was no significant difference in DASH score or incidence of complications between the treatment groups(P>0.05).Conclusion Surgical treatment of acute undisplaced or displaced<1 mm scaphoid lumbar fracture results in better grip strength and wrist range of motion than conservative treatment,the fracture healing time and return to work time are shorter,and the incidence of nonunion is lower.The two treatments produced similar results in terms of DASH score and complications.

关 键 词：腕舟骨骨折 手术治疗 保守治疗 非手术治疗 META分析 

分 类 号：R687.3[医药卫生—骨科学]