尺骨远端截骨和干骺端截骨治疗尺骨撞击综合征临床疗效的Meta分析  

Clinical efficacy of ulnar distal diaphyseal osteotomy and metaphyseal osteotomy in the treatment of ulnar impaction syndrome:a Meta analysis

作　　者：丁锦辉 王勤 张重阳 张明勇[1] DING Jin-hui;WANG Qin;ZHANG Chong-yang;ZHANG Ming-yong(Tianyou Hospital Affiliated to Wuhan University of Science and Technology,Wuhan,Hubei,430064,China)

机构地区：[1]武汉科技大学附属天佑医院骨科,湖北省430064

出　　处：《中国骨与关节杂志》2024年第8期634-642,共9页Chinese Journal of Bone and Joint

摘　　要：目的尺骨撞击综合征(ulnar impaction syndrome,UIS)的手术治疗主要方法为尺骨短缩截骨术(ulnar shortening osteotomy,USO),该术根据截骨部位主要分为尺骨远端骨干截骨(distal diaphyseal ulnar shortening osteotomy,DDUSO)和尺骨干骺端截骨(distal metaphyseal ulnar shortening osteotomy,DMUSO)。两种术式皆被证实安全可靠,但对于最优截骨部位选择,目前临床尚未统一标准。因此,本研究系统评价比较DMUSO与DDUSO治疗UIS的临床疗效。方法系统检索中国知网、万方、维普、PubMed、EMbase、Cochrane数据库,根据纳入和排除标准,收集关于尺骨远端截骨和干骺端截骨治疗UIS的对照试验及回顾研究,检索时限为自建库至2023年3月,对检索到的文献进行筛选、评价和数据提取,使用RevMan5.3软件进行图形绘制和数据分析。结果最终纳入7篇文献,皆为回顾性研究,英文文献4篇,中文3篇,共219例(干骺端截骨组99例,尺骨远端截骨组120例)。结果显示,DDUSO在手术时间[MD=-19.60,95%CI(-35.24,-3.96),P<0.05]、骨折愈合时间[MD=-0.88,95%CI(-1.14,-0.62),P<0.05]、握力[MD=3.07,95%CI(1.63,4.50),P<0.05]、疼痛视觉模拟评分(visual analogue scale,VAS)[MD=-0.87,95%CI(-1.01,-0.73),P<0.05]、腕关节功能评分[MD=8.53,95%CI(5.52,11.50),P<0.05]、腕关节旋转活动度[MD=6.4,95%CI(2.98,9.86),P<0.05]优于尺骨远端截骨组,而在不良反应发生率、腕关节活动度屈伸、尺桡偏方面,两种截骨术式并未表现出明显差异(P均>0.05)。结论与尺骨远端截骨术式相比,干骺端截骨治疗UIS可以更好地缩短手术时间,促进骨愈合,缓解疼痛,改善腕关节功能,提高腕关节旋转活动度,可作为尺骨远端截骨的替代治疗术式,值得临床推广应用。Objective Ulnar shortening osteotomy(USO)is a major surgical treatment of ulnar impaction syndrome(UIS),which is mainly divided into distal diaphyseal and metaphyseal ulnar shortening osteotomy according to the location of the amputation.Both procedures have been shown to be safe and reliable,but there is no uniform clinical criteria for optimal site selection.Therefore,we systematically evaluated the clinical efficacy comparing the treatment of distal metaphyseal ulnar shortening osteotomy(DMUSO)with distal diaphyseal ulnar shortening osteotomy(DDUSO)for ulnar impaction syndrome.Methods PubMed,EMBASE,Cochrane Library,Wanfang,Weip and CNKI were systematically searched for reports published before March 2023.The controlled trial and retrospective study of distal diaphyseal and metaphyseal ulnar shortening osteotomy for the treatment of ulnar impingement syndrome were collected according to inclusion and exclusion criteria.The retrieved literatures were screened and evaluated.The data were extracted,graphed and analyzed using RevMan5.3.Results Seven literatures with 219 cases(99 in metaphyseal and 120 in diaphyseal osteotomy)were included in the retrospective study,4 in English and 3 in Chinese.Meta analyis showed that the treatment of DMUSO was better on operation time[MD=-19.60,95%CI(-35.24,-3.96),P<0.05],fracture healing time[MD=-0.88,95%CI(-1.14,-0.62),P<0.05],grip strength[MD=3.07,95%CI(1.63,4.50),P<0.05],VAS pain score[MD=-0.87,95%CI(-1.01,-0.73),P<0.05],wrist function score[MD=8.53,95%CI(5.52,11.50),P<0.05]and wrist rotational motion[MD=6.4,95%CI(2.98,9.86),P<0.05].In terms of adverse reaction and wrist range motion(fexion,extension,adduction and abduction),there was no statistically significant difference between the metaphyseal osteotomy group and diaphyseal osteotomy group(P>0.05).Conclusions Compared with ulnar distal diaphyseal osteotomy,the metaphyseal osteotomy will reduce the operation time,promote bone healing,relieve pain,improve the function of wrist joint,and increase the wrist rotational motion.

关 键 词：截骨术 尺骨 矫形外科手术 META分析 尺骨撞击综合征 

分 类 号：R731.7[医药卫生—肿瘤]