Department of Orthopedic Surgery, Temple University, Philadelphia, Pennsylvania 19140, USA.
Am J Sports Med. 2010 May;38(5):1048-53. doi: 10.1177/0363546509355408. Epub 2010 Mar 2.
This study was conducted to provide a statistical analysis of previously reported tarsal navicular stress fracture studies regarding the outcomes and effectiveness of conservative and surgical management.
Systematic review.
A systematic review of the published literature was conducted utilizing MEDLINE through Ovid, PubMed, ScienceDirect, and EBSCOhost. Reports of studies that provided the type of tarsal navicular stress fracture (ie, complete or incomplete), type of treatment, result of that treatment, and the time required to return to full activity were selected for analysis. Using a mixed generalized linear model with study as a random effect and treatment as a fixed effect, cases were separated and compared based on 3 different types of treatment: conservative, weightbearing permitted (WBR); conservative, non-weightbearing (NWB); and surgical treatment. The outcome of the treatment was recorded as either successful or unsuccessful based on radiographic and/or clinical healing of the fracture and time from onset of treatment to return to activity.
There was no statistically significant difference between NWB conservative treatment and surgical treatment regarding outcome (P = .6441). However, there is a statistical trend favoring NWB management (96% successful outcomes) over surgery (82% successful outcomes). Weightbearing as a conservative treatment was shown to be significantly less effective than either NWB (P = .0001) or surgical treatment (P <.0003).
Non-weightbearing conservative management should be considered the standard of care for tarsal navicular stress fractures. The authors could find no advantage for surgical treatment compared with NWB immobilization. However, there is a statistical trend favoring NWB over surgery. Rest or immobilization with weightbearing was inferior to both other treatments analyzed. The authors concluded that conservative NWB management is the standard of care for initial treatment of both partial and complete stress fractures of the tarsal navicular.
本研究旨在对先前报道的跗骨舟状骨应力性骨折研究进行统计学分析，评估保守治疗和手术治疗的结果和疗效。
系统回顾。
通过 Ovid、PubMed、ScienceDirect 和 EBSCOhost 对已发表文献进行系统回顾。选择报告了跗骨舟状骨应力性骨折类型（即完全性或不完全性）、治疗类型、治疗结果以及完全恢复活动所需时间的研究报告进行分析。使用混合广义线性模型，将研究作为随机效应，治疗作为固定效应，根据 3 种不同的治疗方法（保守治疗、允许负重[WBR]；保守治疗、非负重[NWB]；和手术治疗）将病例分开并进行比较。根据骨折的放射学和/或临床愈合以及从治疗开始到恢复活动的时间，将治疗结果记录为成功或失败。
在治疗结果方面，NWB 保守治疗与手术治疗之间无统计学差异（P =.6441）。然而，NWB 管理（96%的治疗结果成功）比手术治疗（82%的治疗结果成功）有统计学上的优势。保守治疗中负重与 NWB（P =.0001）或手术治疗（P <.0003）相比，效果明显较差。
对于跗骨舟状骨应力性骨折，应将 NWB 保守治疗作为标准治疗方法。作者未发现手术治疗与 NWB 固定相比具有优势。然而，NWB 比手术治疗有统计学上的优势。负重休息或固定比其他两种治疗方法都差。作者得出结论，对于跗骨舟状骨部分和完全性应力性骨折的初始治疗，NWB 保守治疗是标准治疗方法。
