| Objective1To explore different treatment effect of fresh nondisplaced scaphoid waist fracture,by Meta-analysis of the literature published at home and abroad as well as to compare the clinical cases.2To explore the changes of the blood supply the proximal part after scaphoid waist fracture and provide reference data for best treatment on the fresh nondisplaced scaphoid waist fractures, by MRI follow-up examinations on fresh nondisplaced scaphoid waist fracture cases.Method1Both at home and abroad in1971-2012May have been published and unpublished by surgery or nonoperative treatment technology comparison, treatment of adult (> eighteen years old) acute scaphoid waist fracture curative effect of all randomized controlled trials as the research object. Retrieval MEDLINE(1971to2012), EMbase(1985to2012), PubMed NRR CCT., the Chinese Biomedical Literature Database (CBM), Chinese HowNet (CNKI), Chinese journals full-text database, the National Science and Technology Library, a collection scaphoid fracture of randomized controlled trials comparing surgery with conservative treatment of adult acute (random contrast trials, RCT), after the methodological quality assessment and data extraction of the included studies, using RevMans.5Software for Meta-analysis.2. To select41cases of unplaced (displacement<1mm) fresh (<14days) scaphoid waist fracture patients hospitalized since September2008to June2012, and divide them into three groups, were selected using three different methods of treatment:group A were treated with cast fixation, group B were treated with open reduction and Kirschner wire fixation, group C were treated with open reduction and compression screw fixation. And in the three groups of patients with fracture union time, time off work, wrist function outcome and other indicators were followed up.3. To select7fresh scaphoid waist fracture patients taken the volar forearm cast immobilization fixation. The fixed range far end includes thumb interphalangeal joint and the heel of palm nearly horizontal stripes. MRI follow-up examinations are taken on these seven patients for6months.Results1.Nine the RCT type of research papers were bring into Meta analysis study, a total of501patients. The meta-analysis showed that fracture union time, time off work of the surgery group are shorter than the immobilization group (P<0.0001), the wrist joint activities and grip strength of the surgical group are worse than immobilization group (P<0.00001), nonunion rate of the surgical group (P=0.002) is lower than the immobilization group, and the surgical complications compared with immobilization group has no obvious difference (P=0.74).2. Comparing three clinical surgical methods and results, we found:fracture union time of the immobilization group longer than the surgery group (A group and B group:P=0.028, the A and C groups:P=0.001), Kirschner wire group and screw group is no significant difference (P=0.150); compared with the other two groups, the time off work of screw group is the shortest (group B and group C, P=0.012, group A and group C, P=0.000), and the time off work of immobilization group is the longest (group A and group B, P=0.001, group A and group C, P=0.000); there is no significant differences on the wrist function Jiranek ratings of three treatments (Total pairwise comparisons:group A and group B, P=0.384, group B and group C, P=0.588, group A and group C, P=0.170; subjective ratings twenty-two comparison: group A and B group P=0.243, group B and group C,P=0.844, group A and group C, P=0.188; objective scoring pairwise comparisons:group A and group B, P=0.805, group B and group C, P=0.518, group A and group C,P=0.373).3. Six cases of fracture are healed and do not appear fracture near end ischemia in7cases of fresh scaphoid waist fracture patients, after taken volar forearm plaster immobilization treatment,and1case finally appears nonunion.Conclusion To create optimized local mechanical environment is one of the important conditions of good fracture healing. Unreliable fixed can cause fracture of the scaphoid waist delayed union and ununion, and the vascular anatomical characteristics are not the most important factors. Telayed union and ununion is caused mainly by the distinctive position of scaphoid and the inappropriate mechanical environment after fracture. Therefore, early firm reliable fixation after the fracture of the scaphoid waist can bring good fracture healing results. |
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