经皮螺钉置入固定与石膏固定治疗急性无移位性腕舟骨骨折的系统评价

背景：国内外在经皮螺钉置入固定与石膏固定治疗急性无移位性腕舟骨骨折方面有较多的临床经验,但尚缺乏循证医学方面的依据。 目的：系统评价经皮螺钉置入固定与石膏固定治疗急性无移位性腕舟骨骨折的疗效和安全性。 方法：计算机检索Medline、EMBASE、Cochrane library、中国期刊全文数据库、中国生物医学文献数据库,有关国内外已发表的采用经皮螺钉置入固定与石膏固定治疗急性无移位性腕舟骨骨折的随机对照试验。 结果与结论：纳入4个随机对照试验,175例患者。Meta分析表明,与石膏固定相比,经皮螺钉置入固定可缩短骨折愈合时间SMD=-8.83,95%CI(-10.45,-7.21), P < 0.000 01],减少重返工作时间MD=-6.86,95%CI (-7.17,-6.56),P < 0.000 01],较好恢复腕关节活动SMD=1.79,95%CI (1.23,2.36),P < 0.000 01],提高握持力 MD=3.53, 95%CI (2.52,4.54),P < 0.000 01];两组并发症发生率差异无显著性意义RR=0.50, 95%CI(0.22,1.14),P=0.10]。说明经皮螺钉置入固定治疗急性无移位性腕舟骨骨折疗效优于石膏固定治疗,由于该系统评价纳入研究数量和质量的局限性,对于两者的疗效和安全性分析尚需更多高质量的大样本随机对照试验进一步证实。 关键词：舟骨骨折;经皮螺钉置入固定;石膏固定;系统评价;Meta分析 doi:10.3969/j.issn.1673-8225.2012.13.025

Percutaneous screw insert fixation versus cast immobilization treatment for acute nondisplaced carpal scaphoid fracture: A systematic review

BACKGROUND: There are some clinical experiences for percutaneous screw insert fixation and cast immobilization treatment for acute nondisplaced carpal scaphoid fracture. However, relevant evidence-based medicine studies are rare.  OBJECTIVE: To assess the effectiveness and safety of percutaneous screw insert fixation and cast immobilization treatment for acute nondisplaced carpal scaphoid fracture. METHODS: Relevant domestic and abroad published randomized controlled trials (RCTs) of percutaneous screw insert fixation and cast immobilization treatment for acute nondisplaced carpal scaphoid fracture were searched from Medline, EMBASE, Cochrane library, CNKI and CBM databases by computer. RESULTS AND CONCLUSION: Four randomized controlled trials (RCTs) involved 175 patients. The results of Meta-analysis showed that the fracture healing time (SMD=-8.83, 95%CI -10.45 to -7.21, P < 0.000 01) and off work time (MD=-6.86, 95%CI -7.17 to -6.56, P < 0.000 01) in the percutaneous screw insert fixation group were shorter than those in cast immobilization group; the wrist motion (SMD=1.79, 95%CI 1.23 to 2.36, P < 0.000 01) and grip strength (MD=3.53, 95%CI 2.52 to 4.54, P < 0.000 01) were better in the percutaneous screw insert fixation group; the differences of complications had no statistical significance (RR=0.50, 95%CI 0.22 to 1.14, P=0.10). It indicates that percutaneous screw insert fixation treatment for acute nondisplaced carpal scaphoid fracture is superior to cast immobilization treatment. Due to the small sample and limitation of quality in this review, the effectiveness and safety analysis are still needs more high quality and large scale samples of RCTs to get further confirm