Department of Orthopaedic Surgery, Hanyang University College of Medicine, Seongdon, Seoul, Republic of Korea.
Department of Orthopaedic Surgery, Myoungji Hospital, Deogyang-gu, Goyang-si, Republic of Korea.
J Hand Surg Eur Vol. 2023 Jul;48(7):625-629. doi: 10.1177/17531934221150331. Epub 2023 Jan 28.
We systematically reviewed the incidence of complications and outcomes of different surgical methods for acute perilunate injury in the MEDLINE, Scopus, Embase and Cochrane Library databases. Forty-three articles with 880 patients were included. The most common complications were arthritis (30%), carpal instability (15%), avascular necrosis of the lunate (12%), complex regional pain syndrome (11%), and nonunion or avascular necrosis of the scaphoid (9%). In the meta-analysis, the mean scapholunate gap was 1.7 mm in the closed surgery group and 2.3 mm in the open surgery group, which was a statistically significant difference. The mean flexion-extension arc of the wrist and modified Mayo wrist score were better in the closed surgery group than in the open surgery group. However, these findings may relate to different cohorts in terms of injury severity. Therefore, the causal relationship between closed surgery and better outcomes may be uncertain as less severe subluxations are more likely to be treated closed.
我们系统地检索了 MEDLINE、Scopus、Embase 和 Cochrane Library 数据库中治疗急性月骨周围损伤的不同手术方法的并发症发生率和结局，共纳入 43 篇文章，涉及 880 例患者。最常见的并发症为关节炎（30%）、腕不稳定（15%）、月骨缺血性坏死（12%）、复杂性区域疼痛综合征（11%）和舟状骨骨不连或缺血性坏死（9%）。荟萃分析显示，闭合手术组的舟月间隙平均为 1.7mm，开放手术组为 2.3mm，差异有统计学意义。闭合手术组的腕关节屈伸弧和改良 Mayo 腕关节评分均优于开放手术组。然而，这些发现可能与损伤严重程度的不同队列有关。因此，闭合手术与更好结局之间的因果关系可能不确定，因为更轻微的半脱位更可能通过闭合治疗。
