University Hospitals of Leicester NHS Trust, Leicester, UK.
Pulvertaft Hand Centre, Royal Derby Hospital, Derby, UK.
Bone Joint J. 2022 Aug;104-B(8):953-962. doi: 10.1302/0301-620X.104B8.BJJ-2022-0085.R2.
There has been an increasing use of early operative fixation for scaphoid fractures, despite uncertain evidence. We conducted a meta-analysis to evaluate up-to-date evidence from randomized controlled trials (RCTs), comparing the effectiveness of the operative and nonoperative treatment of undisplaced and minimally displaced (≤ 2 mm displacement) scaphoid fractures.
A systematic review of seven databases was performed from the dates of their inception until the end of March 2021 to identify eligible RCTs. Reference lists of the included studies were screened. No language restrictions were applied. The primary outcome was the patient-reported outcome measure of wrist function at 12 months after injury. A meta-analysis was performed for function, pain, range of motion, grip strength, and union. Complications were reported narratively.
Seven RCTs were included. There was no significant difference in function between the groups at 12 months (Hedges' g 0.15 (95% confidence interval -0.02 to 0.32); p = 0.082). The complication rate was higher in the operative group and involved more serious complications.
We found no difference in functional outcome at 12 months for fractures of the waist of the scaphoid with ≤ 2 mm displacement treated operatively or nonoperatively. The complication rate was higher with operative treatment. Cite this article: 2022;104-B(8):953-962.
尽管证据不确定，但掌骨骨折的早期手术固定的应用越来越多。我们进行了一项荟萃分析，以评估最新的随机对照试验（RCT）证据，比较未移位和轻度移位（≤2 毫米移位）掌骨骨折的手术和非手术治疗的效果。
从各数据库建立日期至 2021 年 3 月底，对七个数据库进行系统评价，以确定符合条件的 RCT。纳入研究的参考文献列表进行了筛选。未应用语言限制。主要结局是受伤后 12 个月时患者报告的手腕功能测量结果。对功能、疼痛、活动范围、握力和愈合进行了荟萃分析。并发症以叙述性方式报告。
纳入了 7 项 RCT。两组在 12 个月时的功能无显著差异（Hedges' g 0.15（95%置信区间 -0.02 至 0.32）；p = 0.082）。手术组的并发症发生率更高，涉及更严重的并发症。
我们发现，对于≤2 毫米移位的掌骨腰部骨折，手术和非手术治疗在 12 个月时的功能结果没有差异。手术治疗的并发症发生率更高。
