手术与非手术治疗成人急性无移位性舟骨骨折的系统评价_《中国循证医学杂志》

作者：

 李斌 ¹ , 袁宏 ¹ , 白靖平 ² , 锡林宝勒日 ²

1. 新疆自治区人民医院骨一科（乌鲁木齐?830001）；2. 新疆医科大学第三附属肿瘤医院（乌鲁木齐?830011）;

关键词：

急性无移位性舟骨骨折经皮螺钉内固定石膏固定随机对照试验系统评价

DOI：

10.7507/1672-2531.20090149

视频：

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目的　系统评价手术与非手术比较治疗成人急性无移位性舟骨骨折的疗效及并发症。
方法　电子检索Cochrane Library（CCTR）及Cochrane 协作网肌骨组专业试验数据库、MEDLINE（1966～2007）、EMbase（1980～2007），PubMed NRR、CCT和中国生物医学文献数据库（CBM）等，手工检索中文骨科杂志，收集手术与非手术比较治疗成人急性无移位性舟骨骨折的随机对照试验，对纳入研究进行方法学质量评价和资料提取后，采用RevMan 4.2.8软件进行Meta分析。
结果　共纳5个RCT，包括269例患者。Meta分析结果显示，重返工作时间，手术组较非手术组更短［WMD= –7.03，95%CI（–7.58，–6.48），P lt;0.000 01］；骨折愈合时间和腕部握持力，因无法合并，结果不一，但均显示出有利于手术组的趋势；在腕关节活动范围［OR=1.01，95%CI（0.52，1.95），P=0.99］和骨折不愈合上（P=0.07），两组差异无统计学意义。
结论　与非手术治疗相比，手术治疗成人急性无移位性舟骨骨折，患者重返工作时间更短，骨折愈合时间和腕部握持力显示出更优的趋势，而腕部活动范围和并发症两组差异无统计学意义。因本系统评价纳入的病例数较少，该结论尚需开展更多设计严格的大样本随机对照试验加以验证。

引用本文： 李斌,袁宏,白靖平,锡林宝勒日. 手术与非手术治疗成人急性无移位性舟骨骨折的系统评价. 中国循证医学杂志, 2009, 09(8): 844-848. doi: 10.7507/1672-2531.20090149 复制

1.	Canalez ST, 主编. 卢世璧, 主译. 坎贝尔骨科手术学. 第9版. 济南: 山东科学技术出版社. 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, Törnkvist 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, 主编. 卢世璧, 主译. 坎贝尔骨科手术学. 第9版. 济南: 山东科学技术出版社. 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, Törnkvist 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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《中国循证医学杂志》

手术与非手术治疗成人急性无移位性舟骨骨折的系统评价

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《中国循证医学杂志》

手术与非手术治疗成人急性无移位性舟骨骨折的系统评价

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