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首页> 外文期刊>Injury >Operative versus nonoperative treatment of acute undisplaced and minimally displaced scaphoid waist fractures--a systematic review.
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Operative versus nonoperative treatment of acute undisplaced and minimally displaced scaphoid waist fractures--a systematic review.

机译：急性非移位和最小移位舟骨腰部骨折的手术治疗与非手术治疗-系统评价。

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INTRODUCTION: Undisplaced and minimally displaced scaphoid waist fractures can be managed either operatively (percutaneous or ORIF) or non-operatively with both methods obtaining high rates of fracture union and subsequent return of function. The aim of this systematic review is to identify and evaluate the best available evidence to determine whether they should be managed operatively or non-operatively. MATERIALS AND METHODS: A Medline and journal hand search was performed with strict eligibility criteria to obtain the highest quality evidence from meta-analyses, randomised controlled trials (RCT) and comparative studies. Included studies were critically appraised using levels of evidence and RCTs were further appraised using a scoring tool. RESULTS: The search found 112 studies, of which 12 met the eligibility criteria for inclusion. Three level 1 RCTs, three level 2 RCTs, two meta-analyses, one economic analysis, and three retrospective studies were critically appraised. The evidence suggests that percutaneous fixation may result in faster union rates by approximately 5 weeks and an earlier return to sport and work by approximately 7 weeks over cast treatment. This difference is not seen when comparing ORIF with cast treatment. Although cast treatment results in a higher non-union rate than ORIF, this needs to be balanced with the 30% minor complication rate. Manual workers require significantly longer time off work than non-manual workers regardless of the method of treatment, although they did return to work sooner after ORIF than after cast treatment. CONCLUSION: The majority of these injuries can be treated in a cast with good results. Operative treatment should be reserved for patients unable to work in a cast and considered for most manual workers and high-level athletes.
机译：简介：可以通过手术（经皮或ORIF）或非手术方式对未移位和移位最小的舟状腰椎骨折进行治疗，这两种方法均能获得较高的骨折愈合率和随后的功能恢复。该系统评价的目的是确定和评估最佳的现有证据，以确定应对其进行手术还是非手术治疗。材料与方法：按照严格的资格标准进行了Medline和期刊手工检索，以从荟萃分析，随机对照试验（RCT）和比较研究中获得最高质量的证据。使用证据水平对纳入研究进行严格评估，并使用评分工具进一步评估RCT。结果：搜索发现112项研究，其中12项符合纳入标准。严格评估了三个一级RCT，三个二级RCT，两项荟萃分析，一项经济分析和三项回顾性研究。有证据表明，经皮固定可能比铸模治疗的联合率快约5周，而运动和工作则较早地恢复约7周。将ORIF与浇铸处理进行比较时，看不到这种差异。尽管铸造治疗的不愈合率高于ORIF，但需要与30％的轻微并发症率保持平衡。无论采用何种治疗方法，体力劳动者需要的休假时间都比非体力劳动者要长得多，尽管他们在ORIF之后确实比在石膏治疗后更快地恢复了工作。结论：这些伤害中的大多数可以通过石膏模型进行治疗，效果良好。手术治疗应保留给无法在演员阵容中工作的患者，并应考虑为大多数体力劳动者和高级运动员使用。

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