掌及背侧经皮微创入路螺钉内固定治疗舟骨骨折疗效的Meta分析

Minimally invasive volar and dorsal percutaneous screw fixation for scaphoid fractures:a Meta-analysis

目的 比较掌侧入路与背侧入路微创经皮螺钉内固定治疗舟骨骨折的疗效,并评估二者的有效性与安全性。方法 根据Cochrane系统评价的方法,检索2000年1月至2021年1月PubMed、Medline、Embase、Cochrane Library、中国生物医学文献数据库(CBM)、中国知网(CNKI)及万方数据库等数据库中关于掌侧入路与背侧入路微创经皮螺钉内固定治疗舟骨骨折的疗效对比研究,根据特定的纳入与排除标准筛选文献,按照Cochrane评价手册和纽卡斯尔-渥太华量表(Newcastle-Ottawa Scale,NOS)进行质量评价,采用Review Manager 5.4进行Meta分析。结果 共纳入8项研究。Meta分析结果显示,经皮掌侧入路组在术后腕关节尺偏活动度[WMD=1.68,95%CI (0.41,2.94),P=0.009]、术中出血量[WMD=-5.87,95%CI (-6.92,-4.82),P <0.00 001]方面优于经皮背侧入路组,差异有统计学意义(P <0.05);但经皮背侧入路组在手术时间[WMD=3.21,95%CI (0.96,5.47),P=0.005]、螺钉与舟骨长轴的夹角[WMD=3.07,95%CI (1.22,4.93),P=0.001]和螺钉与骨折线的夹角[WMD=-7.74,95%CI (-10.11,-5.38),P <0.00 001]方面优于经皮掌侧入路组,差异有统计学意义(P <0.05)。两组在腕关节功能评估及骨折不愈合率方面的差异无统计学意义(P≥0.05)。结论 经皮掌侧入路的术式虽然手术时间相对较长,螺钉放置位置也不如背侧入路,但其能获得更好的腕关节活动度,术中出血量更少,术后腕关节功能恢复更好,安全性更高。

Objective To compare the efficacy of minimally invasive percutaneous screw fixation in the treatment of scaphoid fractures using a volar approach or a dorsal approach,and to evaluate the results and safety of the two approaches.Methods According to the Cochrane systematic evaluation method,literatures retrieved from PubMed,Medline,Embase,Cochrane Library,China Biomedical Literature Database(CBM),CNKI,Wanfang Database and other databases between January 2000 and January 2021 were analyzed to compare the efficacy of palmar and dorsal approach minimally invasive percutaneous screw fixation for scaphoid fractures.Quality was assessed according to the Cochrane evaluation manual and the NOS scale,and Meta-analysis was performed using Review Manager 5.4.Results A total of 8 studies were included.Meta-analysis results showed that the postoperative wrist ulnar deviated motion[WMD=1.68,95%CI(0.41,2.94),P=0.009]and intraoperative blood loss[WMD=-5.87,95%CI(-6.92,-4.82),P 0.00001]in the percutaneous volar approach group were better than that in the percutaneous dorsal approach group with signiflcant differences(P 0.05);however,the operation time[WMD=3.21,95%CI(0.96,5.47),P=0.005],the angle between screw and scaphoid axis[WMD=3.07,95%CI(1.22,4.93),P=0.001]and the angle between screw and fracture line[WMD=-7.74,95%CI(-10.11,-5.38),P 0.00001]in the percutaneous dorsal approach group were better than that in the percutaneous volar approach group with statistical signiflcance(P 0.05).There were no signiflcant differences in wrist joint function assessment and fracture nonunion rate between the two groups(P≥0.05).Conclusions According to current evidence,the operation time of percutaneous volar approach is relatively longer and the screw placement is not as good as dorsal approach.However,it can achieve better range of motion of wrist,less intraoperative blood loss,better postoperative wrist function recovery and higher safety.