尺侧腕掌骨骨折及骨折脱位。系统评价和出版指南。
Ulnar-sided carpometacarpal fractures and fractures-dislocations. A systematic review and publication guidelines.
机构信息
Hand and Upper Limb Unit, hôpital privé Paul-d'Égine, 35, rue de Musselburgh, 94500 Champigny-sur-Marne, France; Institut de la main Nantes Atlantique, boulevard Charles-Gautier, 44800 Saint-Herblain, France.
Hand and Upper Limb Unit, hôpital privé Paul-d'Égine, 35, rue de Musselburgh, 94500 Champigny-sur-Marne, France.
出版信息
Orthop Traumatol Surg Res. 2020 Dec;106(8):1637-1643. doi: 10.1016/j.otsr.2020.03.039. Epub 2020 Oct 21.
BACKGROUND
Intra-articular fractures and fracture-dislocations of the ulnar-sided carpometacarpal joints (US-CMC) are common and under-reported. Their diagnosis is often delayed or incomplete, and there is no consensus as to the best treatment. The aim of this systematic literature review was to focus on the quality of existing data and to describe in detail the available evidence on the diagnosis and treatment of these lesions. Based on our findings, we will propose guidelines for improving the design of future studies on these lesions.
METHODS
This systematic literature review looked at all articles published between 1918 and 2019 on US-CMC fractures and fracture-dislocations. The quality of the articles was evaluated using the Quality Appraisal Tool devised by Moga et al. Information on the diagnostic and therapeutic methods were extracted along with epidemiological data, classifications, and clinical and radiological outcomes.
RESULTS
Of the 500 articles identified, 13 were included. According to the Quality Appraisal Tool, three of these articles had acceptable quality. While either radiographs or CT scans were used for the diagnosis, the radiographs were insufficient to precisely describe the lesions and guide the treatment. Conservative treatment or percutaneous surgical treatment was preferred for acute stable lesions without extensive fractures or comminution, while open surgical treatment was used most often in cases of unstable or sub-acute fractures and fracture-dislocations.
DISCUSSION
The current literature on this topic is made up of case series with a low level of evidence. CT is needed to assess and classify these lesions and select between conservative and surgical treatment. Unstable cases or those with delayed presentation should be treated with an open surgical approach. Based on our findings, we propose reporting guidelines for future studies on the treatment of US-CMC fractures and fracture-dislocations.
LEVEL OF EVIDENCE
III.
背景
关节内骨折和尺侧腕掌关节（US-CMC）骨折脱位较为常见，但报道较少。这些骨折的诊断往往被延误或不完整，对于最佳治疗方法也没有共识。本系统文献回顾的目的是关注现有数据的质量，并详细描述这些病变的诊断和治疗的现有证据。根据我们的发现，我们将提出改善这些病变未来研究设计的指南。
方法
本系统文献回顾分析了 1918 年至 2019 年间发表的所有关于 US-CMC 骨折和骨折脱位的文章。使用 Moga 等人设计的质量评估工具评估文章的质量。提取有关诊断和治疗方法的信息，以及流行病学数据、分类和临床及影像学结果。
结果
在确定的 500 篇文章中，有 13 篇被纳入。根据质量评估工具，其中 3 篇文章的质量是可以接受的。虽然诊断时可以使用 X 线片或 CT 扫描，但 X 线片不足以精确描述病变并指导治疗。对于没有广泛骨折或粉碎的急性稳定病变，建议采用保守治疗或经皮手术治疗，而不稳定或亚急性骨折和骨折脱位则多采用开放手术治疗。
讨论
目前关于这个主题的文献由低证据水平的病例系列组成。需要 CT 来评估和分类这些病变，并在保守治疗和手术治疗之间进行选择。不稳定的病例或延迟就诊的病例应采用开放手术治疗。根据我们的发现，我们提出了治疗 US-CMC 骨折和骨折脱位的未来研究报告指南。
证据水平
III。
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