治疗肩胛骨非整复的移植物选择：综述。

IF 0.9 4区医学 Q4 ORTHOPEDICS

Hand Surgery & Rehabilitation Pub Date : 2024-09-01 DOI:10.1016/j.hansur.2024.101759

Abeer Baamir , Octave Dhellemmes , Dorothée Coquerel-Beghin , Isabelle Auquit-Auckbur

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引用次数: 0

摘要

导言：自 Matti 和 Russe 推出无血管骨移植、血管移植以及最近的游离血管骨移植以来，肩胛骨不愈合的技术选择一直存在争议。本研究旨在通过综述解决以下问题：不同技术的结合率是否存在差异？是否有迹象表明一种技术优于另一种技术？2023 年 9 月进行的总括综述包括系统综述和荟萃分析。主要标准是不同技术的平均结合率。次要标准是根据未愈合类型确定的适应症。根据《系统综述和荟萃分析首选报告项目》（PRISMA，2020 年版）的标准，采用预定义的方法对 PubMed、Cochrane 和 MEDLINE 数据库进行了检索。纳入的系统性综述的质量由 "系统性综述方法学质量评估 "工具（AMSTAR 2）进行评估：结果：共纳入 9 项研究（系统综述或荟萃分析）。质量从低到高不等。我们制作了一个表格来总结每篇文章的定性研究结果。在 9 项研究中，有 8 项研究发现血管化骨移植与非血管化骨移植的结合率无明显差异：血管化骨移植为 84-92%；非血管化骨移植为 80-88%。一项研究发现，血管化骨移植的结合率更高（RR 1.1；95% CI 1.0-1.2；P = 0.02），但功能结果无显著差异。然而，血管化骨移植在近端骨无血管坏死（血管化骨移植的骨结合率为74-88%，非血管化骨移植为47-62%）和翻修病例中更为有效，而非血管化骨移植在驼背畸形和/或背侧闰节不稳定的病例中失败率较低（IRR 0.7 ± 0.09; P = 0.01）：本综述概述了肩胛骨非愈合的治疗方法。结论：这篇综述概述了肩胛骨非整复的治疗方法，不同技术之间没有明显的整体差异。因此，在选择合适的技术时需要考虑各种因素。

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Graft choice for managing scaphoid non-union: umbrella review

Introduction

Since the introduction of the non-vascularized bone graft by Matti and Russe, followed by vascularized grafts and more recently by free vascularized bone grafts, the choice of technique in scaphoid non-union has been controversial. The purpose of the present study was to address the following questions in an umbrella review: Do union rates differ between techniques? Is there any evidence that one technique is superior to another?

Methods

An umbrella review conducted during September 2023 month included systematic reviews and meta-analyses. The primary criterion was mean union rate according to technique. The secondary criterion was indication according to type of non-union. The PubMed, Cochrane, and MEDLINE databases were searched using a predefined methodology according to the criteria of the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA version 2020). The quality of the systematic reviews included was evaluated by the “Assessing the Methodological Quality of Systematic Reviews” instrument (AMSTAR 2).

Results

Nine studies (systematic reviews or meta-analyses) were included. Quality ranged between low and high. A Table was constructed to summarize the qualitative findings of each article. There was no significant difference in union rates between vascularized and non-vascularized bone grafts in 8 of the 9 studies: vascularized bone graft, 84–92%; non-vascularized bone graft, 80–88%. One study found higher union rates with vascularized bone graft (RR 1.1; 95% CI 1.0–1.2; P = 0.02), but no significant difference in functional results. However, vascularized bone graft was more effective in case of avascular necrosis of the proximal pole (74–88% union for vascularized bone graft vs. 47–62% for non-vascularized bone graft) and in revision cases, while non-vascularized bone graft showed fewer failures in case of humpback deformity and/or dorsal intercalated segment instability (IRR 0.7 ± 0.09; P = 0.01).

Conclusions

This umbrella review provides an overview for management of scaphoid non-union. There were no significant global differences between techniques. Thus, various factors need to be considered when selecting the appropriate technique.

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来源期刊

Hand Surgery & Rehabilitation Medicine-Surgery

CiteScore

1.70

自引率

27.30%

发文量

审稿时长

49 days

期刊介绍： As the official publication of the French, Belgian and Swiss Societies for Surgery of the Hand, as well as of the French Society of Rehabilitation of the Hand & Upper Limb, ''Hand Surgery and Rehabilitation'' - formerly named "Chirurgie de la Main" - publishes original articles, literature reviews, technical notes, and clinical cases. It is indexed in the main international databases (including Medline). Initially a platform for French-speaking hand surgeons, the journal will now publish its articles in English to disseminate its author''s scientific findings more widely. The journal also includes a biannual supplement in French, the monograph of the French Society for Surgery of the Hand, where comprehensive reviews in the fields of hand, peripheral nerve and upper limb surgery are presented. Organe officiel de la Société française de chirurgie de la main, de la Société française de Rééducation de la main (SFRM-GEMMSOR), de la Société suisse de chirurgie de la main et du Belgian Hand Group, indexée dans les grandes bases de données internationales (Medline, Embase, Pascal, Scopus), Hand Surgery and Rehabilitation - anciennement titrée Chirurgie de la main - publie des articles originaux, des revues de la littérature, des notes techniques, des cas clinique. Initialement plateforme d''expression francophone de la spécialité, la revue s''oriente désormais vers l''anglais pour devenir une référence scientifique et de formation de la spécialité en France et en Europe. Avec 6 publications en anglais par an, la revue comprend également un supplément biannuel, la monographie du GEM, où sont présentées en français, des mises au point complètes dans les domaines de la chirurgie de la main, des nerfs périphériques et du membre supérieur.