掌侧入路与背侧入路对腕舟骨骨折愈合率的影响

Effect of volar approach versus dorsal approach on the healing rate of scaphoid bone fractures

目的：探讨掌侧入路与背侧入路对腕舟骨骨折愈合率的影响。方法：中文数据库以“腕舟骨骨折”与“掌侧入路”和“背侧入路”的布尔逻辑搭配结果作为检索词，英文数据库以“scaphoid fractures”与“dorsal”、“volar”及“palmar”的布尔逻辑搭配结果作为检索词。用计算机检索中国知网、万方学术期刊数据库、维普中文期刊数据库、中国生物医学文献服务系统、中国生物医学期刊网引文数据库、Pubmed及Sciencedirect数据库建库至2013年11月收录的所有相关文献。利用Revman5．2统计软件进行统计分析。结果：共纳入9篇文献，涉及435例患者，其中随机对照实验2篇，非随机对照实验7篇；中文文献4篇，外文文献5篇。漏斗图显示文献不存在发表偏倚。掌侧入路组与背侧入路组总的骨折愈合率比较，差异无统计学意义[Z＝149，P＝0．140；OR＝0．420，95％CI（0．140，1．310）]；掌侧入路组术后6～8个月的骨折愈合率优于背侧入路组[Z＝2．840，P＝0．004；OR＝6．930，95％CI（1．820，26．320）]。掌侧入路组与背侧入路组术后并发症发生率比较，差异无统计学意义[Z＝0．590，P＝0．560；OR＝0．760，95％CI（0．310，1．890）]。掌侧入路组与背侧入路组术后腕部活动功能比较，差异无统计学意义[Z＝0．990，P＝0．320；OR＝1．900，95％CI（-1．840，5．840）]。结论：掌侧入路与背侧入路治疗腕舟骨骨折对骨折愈合率的影响没有差异，但经掌侧入路固定的患者骨折愈合更快。

Objective：To explore the effect of volar approach versus dorsal approach on the healing rate of scaphoid bone fractures. Methods：The Boolean logical combination of Scaphoid fractures,Dorsal,Volar and Palmar were used as index terms.All the literatures of controlled trial included from database establishing to November 2013 were retrieved from China national knowledge internet,Wanfang Data-base,Vip Database of Chinese journal,Chinese biomedical literature service system（SinoMed）,Chinese Medical Citation Index（CMCI）, Pubmed and Sciencedirect database through computer,and the statistical analysis was conducted by using Revman5 .2 software.Results：Nine literatures（435 patients）were included in the final analysis,including two randomized controlled trials and seven nonrandomized con-trolled trials,four Chinese literatures and five English literatures.The symmetrical funnel plot demonstrated that there was no publication bi-as.There was no statistical difference in the total fracture healing rate between volar approach and dorsal approach（Z=149,P=0.140;OR=0.420,95%CI（0.140,1.310））.The volar approach surpassed the dorsal approach in the fracture healing rate 6 to 8 months after the surgery（Z=2.840,P=0.004;OR=6.930,95%CI（1.820,26.320））.There was no statistical difference in postoperative complication in-cidences between the two approaches（Z=0.590,P=0.560;OR=0.760,95%CI（0.310,1.890））.There was no statistical difference in postoperative wrist activity function between the two approaches（Z=0.990,P=0.320;OR=1.900,95%CI（-1.840,5.840））.Conclu-sion：There is no difference in fracture healing rate between volar approach and dorsal approach in the treatment of scaphoid bone fracture, while the fracture would heal faster by using volar surgical approach.