文献类型：期刊文献

中文题名：顺行髓内钉与不同逆行技术治疗第5掌骨颈骨折

英文题名：Antegrade intramedullary pins versus different retrograde techniques in treatment of fifth metacarpal neck fractures

作者：谭飞[1,2];王静[1,2];曾健康[1,2];李嘉欢[1,2];李培杰[1,2];汪昕[1,2];乔永杰[2];叶铄[2];周胜虎[2]

第一作者：谭飞

机构：[1]甘肃中医药大学,兰州730000;[2]解放军联勤保障部队第940医院关节外科,兰州730050

第一机构：甘肃中医药大学

年份：2024

卷号：18

期号：6

起止页码：742

中文期刊名：中华关节外科杂志(电子版)

外文期刊名：Chinese Journal of Joint Surgery(Electronic Edition)

收录：CSCD:【CSCD2023_2024】；

基金：兰州市科技计划(2023-2-11);甘肃中医药大学导师专项(2023YXKY015);联勤保障部队第九四〇医院高层次人才培养工程(2024-G3-5);兰州市科技计划(2023-ZD-170);转化医学国家科学中心(上海)上海大学分中心(SUITM-202406)

语种：中文

中文关键词：骨折固定术,髓内钉;掌骨;外科手术;Meta分析

外文关键词：Fracture fixation,intramedullary;Metacarpal bones;Surgical procedures;Metaanalysis

摘要：目的比较顺行髓内钉与不同逆行技术治疗第五掌骨颈骨折的临床疗效。方法检索PubMed、荷兰医学文摘(Embase)、Cochrane图书馆、Web of Science、中国知网、维普及万方等数据库中关于顺行髓内钉与不同逆行技术治疗第5掌骨颈骨折的临床研究。纳入10篇高质量文章,包括随机对照研究、前瞻性及回顾性队列研究。共563名患者均为第五掌骨颈骨折,其中277例患者接受顺行髓内钉固定,286例患者接受不同逆行技术固定。主要观察指标为视觉模拟量表(VAS)、快速上肢功能评分表(Quick DASH)、屈曲度、背伸度及并发症。结果在术后随访3个月时,顺行髓内钉的VAS评分[均数差(MD)=-0.88,95%置信区间(CI)(-1.56,-0.19),P=0.01]优于不同逆行技术,但术后6个月,顺行髓内钉VAS评分与不同逆行技术无差异[MD=-0.6,95%CI(-1.93,0.62),P=0.32]。顺行髓内钉的Quick DASH评分在术后3个月[MD=-4.63,95%CI(-7.86,-1.41),P=0.005]和6个月[MD=-1.46,95%CI(-2.78,-0.13),P=0.03]均优于逆行技术。在屈曲度、背伸度两组间差异均无统计学意义(均为P>0.05)。此外,两组并发症例数过少,不能进行统计学分析。结论顺行髓内钉固定在术后早期疼痛与上肢活动度恢复方面优于逆行技术固定,但两种并发症发生率相当。顺行髓内钉技术可更快地恢复手部功能,因此建议临床医生使用顺行髓内钉固定。
Objective To compare the clinical efficacy of the antegrade intramedullary nailing with different retrograde techniques in the treatment of fifth metacarpal neck fractures.Methods The databases of PubMed,Excerpta Medica Database(Embase),Cochrane Library,Web of Science,China Knowledge Network,China Science and Technology Journal Database(VIP)and Wanfang were searched for clinical studies on the treatment of fifth metacarpal neck fracture(FMNF)by the antegrade intramedullary pins technique versus different retrograde techniques.Ten high-quality articles were included,including randomized controlled studies,prospective and retrospective cohort studies.A total of 563 patients had FMNFs,of which 277 patients underwent fixation with antegrade intramedullary pins and 286 patients underwent fixation with different retrograde techniques.The main observations were visual analogue scale(VAS),quick disability of arm,shoulder and hand(Quick DASH),flexion,dorsal extension and complications.Results At three month after surgery,the VAS score of the antegrade intramedullary pin group[mean difference(MD)=-0.88,95%confidence interval(CI)(-1.56,-0.19),P=0.01]was superior to those of different retrograde techniques groups,but at six months after surgery,the VAS score of the antegrade intramedullary pin group was not statistically different from that of the different retrograde techniques[MD=-0.65,95%CI(-1.93,0.62),P=0.32].The Quick DASH score for the antegrade intramedullary pins was superior to the retrograde technique at three months[MD=-4.63,95%CI(-7.86,-1.41),P=0.005]and at six months[MD=-1.46,95%CI(-2.78,-0.13),P=0.03]after the procedure.There was no difference between the two groups in flexion and dorsal extension(both P>0.05).In addition,the overall complication rate was low in both groups.Conclusions Antegrade intramedullary pins fixation was superior to retrograde technique fixation in terms of early postoperative pain and recovery of upper extremity mobility,but both complication rates were comparable.The antegrade intramedullary pin technique results in faster restoration of hand function,therefore,antegrade intramedullary pin fixation is recommend.