El Sewify Omar, Abi-Rafeh Jad, Legler Jack, Karimi Shayan, Baradaran Aslan, Efanov Johnny I
Faculty of Medicine, Laval University, Quebec, QC G1V0A6, Canada.
Plastic, Reconstructive and Aesthetic Surgery, Department of Surgery, McGill University, Montreal, QC H3G2M1, Canada.
J Clin Med. 2024 Feb 18;13(4):1148. doi: 10.3390/jcm13041148.
: Metacarpal non-unions are complex hand defects that can lead to severe hand impairment. Treatment may require the use of artificial or autologous bone grafts. This systematic review aims to describe the outcomes of bone grafting following metacarpal non-union in an attempt to establish an optimal therapeutic protocol for this complication. : A systematic review was conducted in adherence with PRISMA guidelines. Data collection and analysis were performed in duplicate and confirmed by a third investigator. Our primary outcomes focused on radiological time to bone fusion and rates of non-union. Additionally, functional outcomes and complications were analyzed as means of central tendency. : Eighteen studies were included in the systematic review, accounting for a total of 47 patients. The average follow-up time was 12.4 months. Fourteen studies analyzed radiological outcomes, with atrophic non-union representing the most common type. The time to bone fusion, assessed radiologically, following bone graft was an average of 6.9 months (n = 14), with a 100% rate of union in 42 patients. Regarding patient-reported pain improvement, 76% of patients experienced pain relief. Moreover, all patients reported a complete subjective return to baseline hand function. Adverse events, limited to hematoma and seroma, were seen in three patients, representing a complication rate of 11.8% in the examined population. : Metacarpal non-union can be treated successfully via vascularized and non-vascularized bone grafting. Based on the available evidence, bone grafts demonstrate favorable union rates, post-operative pain reduction, hand function recovery, earlier bone fusion times, and minimal complications in the context of metacarpal non-union management.
掌骨不愈合是复杂的手部缺陷，可导致严重的手部功能障碍。治疗可能需要使用人工骨或自体骨移植。本系统评价旨在描述掌骨不愈合后骨移植的结果，试图为这种并发症建立最佳治疗方案。
按照PRISMA指南进行了系统评价。数据收集和分析由两人独立进行，并由第三位研究者确认。我们的主要结果集中在骨融合的影像学时间和不愈合率。此外，还分析了功能结果和并发症，作为集中趋势的指标。
系统评价纳入了18项研究，共47例患者。平均随访时间为12.4个月。14项研究分析了影像学结果，萎缩性不愈合是最常见的类型。骨移植后经影像学评估的骨融合时间平均为6.9个月（n = 14），42例患者的愈合率为100%。关于患者报告的疼痛改善情况，76%的患者疼痛缓解。此外，所有患者均报告手部功能主观上完全恢复到基线水平。3例患者出现不良事件，仅限于血肿和血清肿，在所检查人群中的并发症发生率为11.8%。
掌骨不愈合可通过带血管和不带血管的骨移植成功治疗。根据现有证据，在掌骨不愈合的治疗中，骨移植显示出良好的愈合率、术后疼痛减轻、手部功能恢复、更早的骨融合时间和最少的并发症。
