手术与非手术治疗成人急性无移位性或者轻度移位性舟骨骨折的系统评价与Meta分析

A systematic evaluation and meta analysis of surgical and nonsurgical treatment for patients with acute nondisplaced or minimally displaced scaphoid fractures

目的系统评价手术与非手术治疗成人急性无移位性或者轻度移位性舟骨骨折的疗效及并发症。方法计算机检索Cochrane图书馆（2011年第10期）、MEDLINE（1966年~2011年）、EMBase（1966年~2011年10月）、中国生物医学文献数据库（1979年1月~2011年10月）、PubMed（1966年6月~2011年10月）、万方数据库和维普数据库,手工检索中文骨科期刊的相关文献。收集手术与非手术治疗成人急性无移位性或者轻度移位性舟骨骨折的随机对照试验（RCT）和半随机对照（Quasi-RCT）,对纳入研究进行方法学质量评价和资料提取后,采用RevMan 5.1软件进行Meta分析。结果共纳入9个RCT,包括490例患者。Meta分析结果显示与非手术组比较,手术组的重返工作时间更短[SMD=2.06,95%CI（-3.46,-0.67）,P=0.004],骨折愈合时间更快[SMD=5.88,95%CI（-9.23,-2.54）,P=0.0006];但手术治疗后舟大多角骨关节骨性关节炎发病率增高[RR=3.72,95%CI（1.61,8.63）,P=0.002],而其他指标如治疗后的手握力、腕关节掌屈和背伸角度、DASH评分和PRWE评分、骨不连发生率、桡腕关节骨性关节炎发病率的差异无统计学意义。结论与非手术组治疗相比,对于成人急性无移位性或者轻度移位性舟骨骨折,手术的患者可以更早的返回工作岗位和骨折愈合更快,但是舟大多角骨关节骨性关节炎发病率增高。

Objective To systematically evaluate the clinical efficacy and complications of surgical and nonsurgical treatment for patients with acute nondisplaced or minimally displaced scaphoid fractures.Methods Relevant literature on orthopedics was reviewed from Coehrane library,Cochrane database（2011）,MEDLINE（January 1966 to October 2011）,EMbase（June 1966 to October 2011）,CBM（January 1979 to October 2011）,PubMed（June 1966 to October 2011）,Wanfang database and CQVIP database.Data of randomized controlled trials（RCTs） and quasi-randomized controlled trials（Quasi-RCTs） on treatment for acute nondisplaced or minimally displaced scaphoid fractures were collected.Metaanalysis was conducted by using the Cachrane Collaboration′s RevMan 5.1 software.Results Nine RCTs involving 559 patients were performed in the study.The meta analysis revealed that the surgical group had shorter time from surgery to going back to work[SMD=-2.06,95%CI（-3.46,-0.67）,P=0.004],faster fracture recovery [SMD=-5.88,95%CI（-9.23,-2.54）,P=0.0006],but the rate of osteoarthritis of the scaphotrapezial joint was higher than nonsurgical group[RR=3.72,95%CI（1.61,8.63）,P=0.002].No significant differences were found between the two groups in terms of the grip strength,wrist motion,DASH-score and PRWE-score,and incidence rates of non-union and osteoar-thritis of the radiocarpal joint.Conclusion Compared with nonsurgical group,patients in the surgical group can go back to work earlier and recover faster after adult nondisplaced or minimally displaced scaphoid fractures,but the rate of osteoarthritis of the scaphotrapezial joint is higher.Owing to the limitations of the study,large-scale randomized controlled trials are required for more precise conclusions.