{"title":"治疗肩胛骨非整复的移植物选择：综述。","authors":"Abeer Baamir , Octave Dhellemmes , Dorothée Coquerel-Beghin , Isabelle Auquit-Auckbur","doi":"10.1016/j.hansur.2024.101759","DOIUrl":null,"url":null,"abstract":"<div><h3>Introduction</h3><p>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?</p></div><div><h3>Methods</h3><p>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).</p></div><div><h3>Results</h3><p>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).</p></div><div><h3>Conclusions</h3><p>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.</p></div>","PeriodicalId":54301,"journal":{"name":"Hand Surgery & Rehabilitation","volume":"43 4","pages":"Article 101759"},"PeriodicalIF":0.9000,"publicationDate":"2024-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2468122924001749/pdfft?md5=19fafb7bb832baf20a95bc3fe279130a&pid=1-s2.0-S2468122924001749-main.pdf","citationCount":"0","resultStr":"{\"title\":\"Graft choice for managing scaphoid non-union: umbrella review\",\"authors\":\"Abeer Baamir , Octave Dhellemmes , Dorothée Coquerel-Beghin , Isabelle Auquit-Auckbur\",\"doi\":\"10.1016/j.hansur.2024.101759\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<div><h3>Introduction</h3><p>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?</p></div><div><h3>Methods</h3><p>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).</p></div><div><h3>Results</h3><p>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).</p></div><div><h3>Conclusions</h3><p>This umbrella review provides an overview for management of scaphoid non-union. There were no significant global differences between techniques. 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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.
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.
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