Ten Berg Paul W L, de Roo Marieke G A, Maas Mario, Strackee Simon D
Department of Plastic, Reconstructive, and Hand Surgery, Academic Medical Center, University of Amsterdam, Room G4-226, Meibergdreef 9, 1105, Amsterdam, AZ, The Netherlands.
Department of Radiology, Academic Medical Center, University of Amsterdam, Room G1-211, Meibergdreef 9, 1105 Amsterdam, AZ, The Netherlands.
Eur J Radiol. 2017 Jun;91:124-129. doi: 10.1016/j.ejrad.2017.03.023. Epub 2017 Mar 31.
The effect of scaphoid nonunion deformity on wrist function is uncertain due to the lack of reliable imaging tools. Advanced three-dimensional (3-D) computed tomography (CT)-based imaging techniques may improve deformity assessment by using a mirrored image of the contralateral intact wrist as anatomic reference. The implementation of such techniques depends on the extent to which conventional CT is currently used in standard practice. The purpose of this systematic review of medical literature was to analyze the trend in CT scanning scaphoid nonunions, either unilaterally or bilaterally.
Using Medline and Embase databases, two independent reviewers searched for original full-length clinical articles describing series with at least five patients focusing on reconstructive surgery of scaphoid nonunions with bone grafting and/or fixation, from the years 2000-2015. We excluded reports focusing on only nonunions suspected for avascular necrosis and/or treated with vascularized bone grafting, as their workup often includes magnetic resonance imaging. For data analysis, we evaluated the use of CT scans and distinguished between uni- and bilateral, and pre- and postoperative scans.
Seventy-seven articles were included of which 16 were published between 2000 and 2005, 19 between 2006 and 2010, and 42 between 2011 and 2015. For these consecutive intervals, the rates of articles describing the use of pre- and postoperative CT scans increased from 13%, to 16%, to 31%, and from 25%, to 32%, to 52%, respectively. Hereof, only two (3%) articles described the use of bilateral CT scans.
There is an evident trend in performing unilateral CT scans before and after reconstructive surgery of a scaphoid nonunion. To improve assessment of scaphoid nonunion deformity using 3-D CT-based imaging techniques, we recommend scanning the contralateral wrist as well.
由于缺乏可靠的成像工具，舟骨不愈合畸形对腕关节功能的影响尚不确定。基于先进的三维（3-D）计算机断层扫描（CT）的成像技术，通过将对侧完整腕关节的镜像作为解剖学参考，可能会改善畸形评估。此类技术的应用取决于传统CT在当前标准实践中的使用程度。本医学文献系统评价的目的是分析单侧或双侧扫描舟骨不愈合的CT扫描趋势。
使用Medline和Embase数据库，两名独立评审员检索了2000年至2015年间描述至少五例患者系列的原始全文临床文章，这些文章重点关注舟骨不愈合的植骨和/或固定重建手术。我们排除了仅关注疑似缺血性坏死的不愈合和/或接受带血管蒂骨移植治疗的报告，因为它们的检查通常包括磁共振成像。为了进行数据分析，我们评估了CT扫描的使用情况，并区分了单侧和双侧以及术前和术后扫描。
纳入77篇文章，其中16篇发表于2000年至2005年，19篇发表于2006年至2010年，42篇发表于2011年至2015年。在这些连续的时间段内，描述术前和术后CT扫描使用情况的文章比例分别从13%增至16%，再增至31%，以及从25%增至32%，再增至52%。其中，只有两篇（3%）文章描述了双侧CT扫描的使用情况。
在舟骨不愈合重建手术前后进行单侧CT扫描有明显趋势。为了使用基于3-D CT的成像技术改善舟骨不愈合畸形的评估，我们建议同时扫描对侧腕关节。
