PDF(Pubmed)
Abstract：
Intramedullary K-wire (IMKW) fixation is one of the mainstays for surgically treating metacarpal shaft and neck fractures. However, there remains a lack of literature comparing outcomes of the various available surgical repair techniques in all indicated metacarpals. Therefore, we conducted a systematic review and meta-analysis to investigate the clinical advantages and drawbacks of IMKW compared with alternate fracture repair techniques. A comprehensive systematic literature review was performed to identify studies that compared clinical outcomes of IMKW to alternate metacarpal fixation modalities. Outcomes included Disabilities of the Arm, Shoulder, and Hand (DASH/ quick DASH) scores, grip strength, union rate, visual analog scale pain, operative time, and complications. A random-effects model was used to compare IMKW to the pooled effect of other fixation techniques. A total of 10 studies were included in our analysis, comprising 497 metacarpal fractures (220 shafts and 277 necks). IMKW fixation was identified as the control group in all studies. The pooled experimental group included plates, transverse K-wires (TKWs), interfragmentary screws (IFSs), and K-wire cross-pinning (CP). In treating metacarpal shaft fractures, IMKW showed significantly shorter operative time ( p = 0.04; mean difference = - 13; 95% confidence interval = -26 to -0.64). No significant differences were observed in treating metacarpal neck fractures for disability, grip strength, healing rate, pain, operative time, or complication rate. This systematic review and meta-analysis found no difference in clinical outcomes among various surgical techniques for treating metacarpal shaft and neck fractures. Further high evidence studies are required that investigate the efficacy and safety of IFS, CP, TKW, and intramedullary screws versus IMKW for treating closed, unstable metacarpal fractures.
摘要：
髓内K线（IMKW）固定是手术治疗掌骨干和颈部骨折的主要方法之一。然而,目前仍缺乏文献比较各种可用的手术修复技术在所有指征掌骨中的结局.因此,我们进行了系统评价和荟萃分析,以探讨IMKW与替代骨折修复技术相比的临床优势和不足.进行了全面的系统文献综述，以确定将IMKW的临床结果与替代的掌骨固定方式进行比较的研究。结果包括手臂残疾，肩膀,和手（DASH/快速DASH）分数，握力,联合汇率，视觉模拟量表疼痛，手术时间,和并发症。使用随机效应模型将IMKW与其他固定技术的合并效应进行比较。共有10项研究纳入我们的分析，包括497个掌骨骨折（220个轴和277个颈）。在所有研究中将IMKW固定确定为对照组。合并的实验组包括平板，横向K线（TKW），碎片螺钉(IFS)，和K线交叉钉扎（CP）。在治疗掌骨骨折时，IMKW显示手术时间明显更短（p=0.04；平均差=-13；95％置信区间=-26至-0.64）。在治疗掌骨颈骨折的残疾方面没有观察到显著差异。握力,治愈率,疼痛,手术时间,或并发症发生率。这项系统评价和荟萃分析发现，在治疗掌骨干和颈骨折的各种手术技术之间，临床结果没有差异。需要进一步的高证据研究来调查IFS的疗效和安全性，CP,TKW,和髓内螺钉与IMKW治疗闭合，不稳定的掌骨骨折.
