Ditsios Konstantinos, Konstantinidis Ioannis, Agas Konstantinos, Christodoulou Anastasios
1st Orthopaedic Department of Aristotle University of Thessaloniki, "Georgios Papanikolaou" General Hospital, Exohi 57010, Thessaloniki, Greece.
Department of Mathematics, Thessaly University, Larissa, Greece.
J Orthop Res. 2017 May;35(5):1076-1085. doi: 10.1002/jor.23242. Epub 2017 Apr 13.
We did a meta-analysis of the literature in order to clarify which of the vascularized bone flaps (VBF) used for scaphoid non-union treatment has the best outcome with regard to various parameters. We analyzed 54 articles that present nine different types of VBF. The analysis concerned demographical patient information, radiographic parameters, fracture classification, including the presence or non-presence of avascular necrosis of the scaphoid proximal pole (PP AVN), parameters that have to do with the surgery itself and the postoperative protocol, the healing of the nonunion and functional scores. The meta-analysis showed best healing potential for the femoral graft despite the complexity of the operation. On the other hand, the most commonly used 1,2-ICSRA flap makes the procedure more reproducible but showed worse results. The femoral flap was also among the most successful flaps when used for patients with PP AVN. The consolidation rate, in general, was not affected by the time elapsed between the fracture and the operation but by smoking and the presence of PP AVN. The meta-analysis could not reach many significant statistical conclusions because of either the small number of patients in some flap groups or the heterogeneity and lack of documentation in most of the articles. © 2017 Orthopaedic Research Society. Published by Wiley Periodicals, Inc. J Orthop Res 35:1076-1085, 2017.
我们对文献进行了荟萃分析，以阐明用于舟骨不愈合治疗的各种带血管蒂骨瓣（VBF）中，就各项参数而言哪种具有最佳疗效。我们分析了54篇介绍9种不同类型VBF的文章。分析涉及患者人口统计学信息、影像学参数、骨折分类，包括舟骨近端极有无缺血性坏死（PP AVN）、与手术本身及术后方案相关的参数、不愈合的愈合情况以及功能评分。荟萃分析表明，尽管手术复杂，但股骨移植骨具有最佳的愈合潜力。另一方面，最常用的1,2 - ICSRA皮瓣使手术操作更具可重复性，但效果较差。当用于PP AVN患者时，股骨皮瓣也是最成功的皮瓣之一。一般来说，愈合率不受骨折与手术之间时间间隔的影响，而是受吸烟和PP AVN的存在影响。由于某些皮瓣组患者数量少，或者大多数文章存在异质性且缺乏记录，荟萃分析未能得出许多具有显著统计学意义的结论。© 2017年骨科学研究协会。由威利期刊公司出版。《矫形外科学研究杂志》2017年第35卷：1076 - 1085页。
