手术与非手术治疗成人急性无移位性舟骨骨折的系统评价

Surgical or Conservative Treatment for Acute Nondisplaced Scaphoid Fractures in Adults:A Systematic Review

目的系统评价手术与非手术比较治疗成人急性无移位性舟骨骨折的疗效及并发症。方法电子检索Cochrane Library(CCTR)及Cochrane协作网肌骨组专业试验数据库、MEDLINE(1966～2007)、EMbase(1980～2007),PubMedNRR、CCT和中国生物医学文献数据库(CBM)等,手工检索中文骨科杂志,收集手术与非手术比较治疗成人急性无移位性舟骨骨折的随机对照试验,对纳入研究进行方法学质量评价和资料提取后,采用RevMan4.2.8软件进行Meta分析。结果共纳5个RCT,包括269例患者。Meta分析结果显示,重返工作时间,手术组较非手术组更短[WMD=-7.03,95%CI(-7.58,-6.48),P<0.00001];骨折愈合时间和腕部握持力,因无法合并,结果不一,但均显示出有利于手术组的趋势;在腕关节活动范围[OR=1.01,95%CI(0.52,1.95),P=0.99]和骨折不愈合上(P=0.07),两组差异无统计学意义。结论与非手术治疗相比,手术治疗成人急性无移位性舟骨骨折,患者重返工作时间更短,骨折愈合时间和腕部握持力显示出更优的趋势,而腕部活动范围和并发症两组差异无统计学意义。因本系统评价纳入的病例数较少,该结论尚需开展更多设计严格的大样本随机对照试验加以验证。

Objective To determine the effectiveness and safety of surgical treatment compared to conservative treatment for adult acute nondisplaced scaphoid fractures. Methods We searched the specialized trials registered in the Cochrane muscle group, The Cochrane Library （CCTR）, MEDLINE （1966 to 2007）, EMbase （1980 to 2007）, PubMed （1966 to 2007）, NRR, CCT, and CBMdisc （1979 to July 2007）. We also handsearched some Chinese orthopedics journals. Randomized controlled trials （RCTs） of surgical treatment versus conservative treatment for adult acute nondisplaced scaphoid fractures were included. The extraction of data and the methodological assessment of included RCTs were performed by two reviewers independently. RevMan software was used to carry out meta-analysis. Results Five RCTs including 269 patients met the inclusion criteria. Compared with conservative treatment, the time taken before returning to work or participation in sports was shorter in the surgical treatment group. Because of inadequate extraction data and heterogeneity in the included studies, the results of the time of union and grip strength were not consistent. But all the results showed favorable tendencies. No significant difference was found in wrist motion and complications between the surgical and conservative treatment groups. Conclusion Compared with conservative treatment for adult acute nondisplaced scaphoid fractures, surgical treatment could decrease the time of returning to work or participation in sports, decrease the time of union, and improve grip strength. But it does not improve the wrist motion or decrease the complications. Because of the small sample size, this conclusion should further tested using well-designed, large scale RCTs.