手術與非手術治療成人急性無移位性舟骨骨折的系統評價_《中國循證醫學雜志》

作者：

 李斌 ¹ , 袁宏 ¹ , 白靖平 ² , 錫林寶勒日 ²

1. 新疆自治區人民醫院骨一科（烏魯木齊?830001）；2. 新疆醫科大學第三附屬腫瘤醫院（烏魯木齊?830011）;

關鍵詞：

急性無移位性舟骨骨折經皮螺釘內固定石膏固定隨機對照試驗系統評價

DOI：

10.7507/1672-2531.20090149

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目的　系統評價手術與非手術比較治療成人急性無移位性舟骨骨折的療效及并發癥。
方法　電子檢索Cochrane Library（CCTR）及Cochrane 協作網肌骨組專業試驗數據庫、MEDLINE（1966～2007）、EMbase（1980～2007），PubMed NRR、CCT和中國生物醫學文獻數據庫（CBM）等，手工檢索中文骨科雜志，收集手術與非手術比較治療成人急性無移位性舟骨骨折的隨機對照試驗，對納入研究進行方法學質量評價和資料提取后，采用RevMan 4.2.8軟件進行Meta分析。
結果　共納5個RCT，包括269例患者。Meta分析結果顯示，重返工作時間，手術組較非手術組更短［WMD= –7.03，95%CI（–7.58，–6.48），P lt;0.000 01］；骨折愈合時間和腕部握持力，因無法合并，結果不一，但均顯示出有利于手術組的趨勢；在腕關節活動范圍［OR=1.01，95%CI（0.52，1.95），P=0.99］和骨折不愈合上（P=0.07），兩組差異無統計學意義。
結論　與非手術治療相比，手術治療成人急性無移位性舟骨骨折，患者重返工作時間更短，骨折愈合時間和腕部握持力顯示出更優的趨勢，而腕部活動范圍和并發癥兩組差異無統計學意義。因本系統評價納入的病例數較少，該結論尚需開展更多設計嚴格的大樣本隨機對照試驗加以驗證。

引用本文： 李斌,袁宏,白靖平,錫林寶勒日. 手術與非手術治療成人急性無移位性舟骨骨折的系統評價. 中國循證醫學雜志, 2009, 09(8): 844-848. doi: 10.7507/1672-2531.20090149 復制

1.	Canalez ST, 主編. 盧世璧, 主譯. 坎貝爾骨科手術學. 第9版. 濟南: 山東科學技術出版社. 2001.
2.	Rayan GM. Fractures and nonunions of the scaphoid. J Okla State Med Assoc, 1996, 89(9): 315-323.
3.	Ford DJ, Khoury G, el-Hadidi S, et al. The Herbert screw for fractures of the scaphoid. A review of results and technical difficulties. J Bone Joint Surg Br, 1987, 69(1): 124-127.
4.	Dias JJ, Brenkel IJ, Finlay DB. Patterns of union in fractures of the waist of the scaphoid. J Bone Joint Surg Br, 1989, 71(2): 307-310.
5.	O’Brien L, Herbert T. Internal fixation of acute scaphoid fractures: a new approach to treatment. Aust N Z J Surg, 1985, 55: 387-389.
6.	Skirven T, Trope J. Complications of immobilization. Hand Clin, 1994, 10(1): 53-61.
7.	Rettig AC, Weidenbener EJ, Gloyeske R. Alternative management of midthird scaphoid fractures in the athlete. Am J Sports Med, 1994, 22(5): 711-714.
8.	Herbert TJ, Fisher WE. Management of the fractured scaphoid using a new bone screw. J Bone Joint Surg Br, 1984, 66(1): 114-123.
9.	Bunker TD, McNamee PB, Scott TD. The Herbert screw for scaphoid fractures. A multicentre study. J Bone Joint Surg Br, 1987, 69(4): 631-634.
10.	Dias JJ, Bhowal B, Wildin CJ, et al. Assessing the outcome of disorders of the hand. Is the patient evaluation measure reliable, valid, responsive and without bias? J Bone Joint Surg Br, 2001, 83(2): 235-240.
11.	Saedén B, T?rnkvist H, Ponzer S, et al. Fracture of the carpal scaphoid. A prospective, randomised 12-year follow-up comparing operative and conservative treatment. J Bone Joint Surg Br, 2001, 83(2): 230-234.
12.	Bond CD, Shin AY, McBride MT, et al. Percutaneous screw fixation or cast immobilization for nondisplaced scaphoid fractures. J Bone Joint Surg Am, 2001, 83-A(4): 483-488.
13.	Adolfsson L, Lindau T, Arner M. Acutrak screw fixation versus cast immobilisation for undisplaced scaphoid waist fractures. J Hand Surg Br, 2001, 26(3): 192-195.
14.	Gaebler C, McQueen MM, Vecser V. Percutaneous screw fixation versus conservatice treatment in undisplaced scapoid fractures. 5th European Trauma Congress in Vienna, 4-8 May 2002.
15.	Dias JJ, Wildin CJ, Bhowal B, et al. Should acute scaphoid fractures be fixed? A randomized controlled trial. J Bone Joint Surg Am, 2005, 87(10): 2160-2168.

1. Canalez ST, 主編. 盧世璧, 主譯. 坎貝爾骨科手術學. 第9版. 濟南: 山東科學技術出版社. 2001.
2. Rayan GM. Fractures and nonunions of the scaphoid. J Okla State Med Assoc, 1996, 89(9): 315-323.
3. Ford DJ, Khoury G, el-Hadidi S, et al. The Herbert screw for fractures of the scaphoid. A review of results and technical difficulties. J Bone Joint Surg Br, 1987, 69(1): 124-127.
4. Dias JJ, Brenkel IJ, Finlay DB. Patterns of union in fractures of the waist of the scaphoid. J Bone Joint Surg Br, 1989, 71(2): 307-310.
5. O’Brien L, Herbert T. Internal fixation of acute scaphoid fractures: a new approach to treatment. Aust N Z J Surg, 1985, 55: 387-389.
6. Skirven T, Trope J. Complications of immobilization. Hand Clin, 1994, 10(1): 53-61.
7. Rettig AC, Weidenbener EJ, Gloyeske R. Alternative management of midthird scaphoid fractures in the athlete. Am J Sports Med, 1994, 22(5): 711-714.
8. Herbert TJ, Fisher WE. Management of the fractured scaphoid using a new bone screw. J Bone Joint Surg Br, 1984, 66(1): 114-123.
9. Bunker TD, McNamee PB, Scott TD. The Herbert screw for scaphoid fractures. A multicentre study. J Bone Joint Surg Br, 1987, 69(4): 631-634.
10. Dias JJ, Bhowal B, Wildin CJ, et al. Assessing the outcome of disorders of the hand. Is the patient evaluation measure reliable, valid, responsive and without bias? J Bone Joint Surg Br, 2001, 83(2): 235-240.
11. Saedén B, T?rnkvist H, Ponzer S, et al. Fracture of the carpal scaphoid. A prospective, randomised 12-year follow-up comparing operative and conservative treatment. J Bone Joint Surg Br, 2001, 83(2): 230-234.
12. Bond CD, Shin AY, McBride MT, et al. Percutaneous screw fixation or cast immobilization for nondisplaced scaphoid fractures. J Bone Joint Surg Am, 2001, 83-A(4): 483-488.
13. Adolfsson L, Lindau T, Arner M. Acutrak screw fixation versus cast immobilisation for undisplaced scaphoid waist fractures. J Hand Surg Br, 2001, 26(3): 192-195.
14. Gaebler C, McQueen MM, Vecser V. Percutaneous screw fixation versus conservatice treatment in undisplaced scapoid fractures. 5th European Trauma Congress in Vienna, 4-8 May 2002.
15. Dias JJ, Wildin CJ, Bhowal B, et al. Should acute scaphoid fractures be fixed? A randomized controlled trial. J Bone Joint Surg Am, 2005, 87(10): 2160-2168.

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手術與非手術治療成人急性無移位性舟骨骨折的系統評價

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