Abstract：
OBJECTIVE: Although proximal row carpectomy (PRC) has increasingly been shown to have superior features to four-corner fusion (4CF), individual surgeons may remain convinced of the superiority of one procedure based on personal experience and individual biases. Hence, we sought to perform an updated meta-analysis with some of the largest studies to date to compare outcomes and complications between these procedures in the treatment of scapholunate advanced collapse and scaphoid nonunion advanced collapse wrists.
METHODS: A systematic review and meta-analysis was performed per Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. PubMed/MEDLINE, Embase, Web of Science, and Cochrane were queried for articles on PRC and 4CF performed for scapholunate advanced collapse and scaphoid nonunion advanced collapse wrist. Primary outcomes included wrist range of motion; grip strength; outcome measures, including Disabilities of Arm, Shoulder, and Hand and Quick Disabilities of Arm, Shoulder, and Hand scores, Patient-Rated Wrist and Hand Evaluation, and visual analog scale pain scores; and surgical complications.
RESULTS: Sixty-one studies reported on 3,174 wrists, of which 54% were treated with PRC and 46% were treated with 4CF. The weighted mean follow-up was 61 months (range, 12-216 months). Meta-analysis comparing PRC and 4CF demonstrated that PRC had significantly greater postoperative extension; ulnar deviation; postoperative improvement in extension, flexion, ulnar deviation; and visual analog scale score. No comparisons showed significant differences in grip strength. The percentage of wrists requiring arthrodesis was 5.2% for PRC and 11% for 4CF. There was an 8.9% (57/640 wrists) 4CF nonunion rate and 2.2% (17/789) hardware removal rate after 4CF.
CONCLUSIONS: In the treatment of scapholunate advanced collapse and scaphoid nonunion advanced collapse wrists, PRC results in better outcomes and a lower complication rate compared to 4CF.
METHODS: Therapeutic IV.
METHODS: A systematic review and meta-analysis was performed per Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. PubMed/MEDLINE, Embase, Web of Science, and Cochrane were queried for articles on PRC and 4CF performed for scapholunate advanced collapse and scaphoid nonunion advanced collapse wrist. Primary outcomes included wrist range of motion; grip strength; outcome measures, including Disabilities of Arm, Shoulder, and Hand and Quick Disabilities of Arm, Shoulder, and Hand scores, Patient-Rated Wrist and Hand Evaluation, and visual analog scale pain scores; and surgical complications.
RESULTS: Sixty-one studies reported on 3,174 wrists, of which 54% were treated with PRC and 46% were treated with 4CF. The weighted mean follow-up was 61 months (range, 12-216 months). Meta-analysis comparing PRC and 4CF demonstrated that PRC had significantly greater postoperative extension; ulnar deviation; postoperative improvement in extension, flexion, ulnar deviation; and visual analog scale score. No comparisons showed significant differences in grip strength. The percentage of wrists requiring arthrodesis was 5.2% for PRC and 11% for 4CF. There was an 8.9% (57/640 wrists) 4CF nonunion rate and 2.2% (17/789) hardware removal rate after 4CF.
CONCLUSIONS: In the treatment of scapholunate advanced collapse and scaphoid nonunion advanced collapse wrists, PRC results in better outcomes and a lower complication rate compared to 4CF.
METHODS: Therapeutic IV.
摘要：
目的：尽管近侧行腕骨切除术（PRC）越来越多地显示出优于四角融合（4CF）的特征，根据个人经验和个人偏见，个别外科医生可能仍然相信一种手术的优越性。因此，我们试图对一些迄今为止规模最大的研究进行更新的荟萃分析,以比较这些手术治疗肩胛骨不连晚期塌陷腕关节的结局和并发症.
方法：根据系统评价和荟萃分析指南的首选报告项目进行系统评价和荟萃分析。PubMed/MEDLINE,Embase,WebofScience,并询问了Cochrane有关PRC和4CF的文章，以进行肩胛骨的晚期塌陷和舟骨骨不连的晚期塌陷。主要结果包括手腕活动范围；握力；结果测量，包括手臂残疾，肩膀,手和手臂的快速残疾，肩膀,和手得分，患者额定腕部和手部评估，和视觉模拟量表疼痛评分；和手术并发症。
结果：61项研究报告了3,174个手腕，其中54%用PRC治疗，46%用4CF治疗。加权平均随访61个月(范围，12-216个月）。比较PRC和4CF的荟萃分析表明，PRC具有明显更大的术后伸展；尺骨偏离；术后伸展改善，屈曲，尺骨偏差；视觉模拟量表评分。没有比较显示握力的显着差异。PRC需要关节固定术的手腕百分比为5.2％，4CF为11％。4CF后骨不愈合率为8.9％（57/640腕部），4CF后骨不愈合率为2.2％（17/789）。
结论：在治疗肩胛骨晚期塌陷和舟骨骨不连晚期塌陷腕上，与4CF相比，PRC结果更好，并发症发生率更低。
方法：治疗IV。
方法：根据系统评价和荟萃分析指南的首选报告项目进行系统评价和荟萃分析。PubMed/MEDLINE,Embase,WebofScience,并询问了Cochrane有关PRC和4CF的文章，以进行肩胛骨的晚期塌陷和舟骨骨不连的晚期塌陷。主要结果包括手腕活动范围；握力；结果测量，包括手臂残疾，肩膀,手和手臂的快速残疾，肩膀,和手得分，患者额定腕部和手部评估，和视觉模拟量表疼痛评分；和手术并发症。
结果：61项研究报告了3,174个手腕，其中54%用PRC治疗，46%用4CF治疗。加权平均随访61个月(范围，12-216个月）。比较PRC和4CF的荟萃分析表明，PRC具有明显更大的术后伸展；尺骨偏离；术后伸展改善，屈曲，尺骨偏差；视觉模拟量表评分。没有比较显示握力的显着差异。PRC需要关节固定术的手腕百分比为5.2％，4CF为11％。4CF后骨不愈合率为8.9％（57/640腕部），4CF后骨不愈合率为2.2％（17/789）。
结论：在治疗肩胛骨晚期塌陷和舟骨骨不连晚期塌陷腕上，与4CF相比，PRC结果更好，并发症发生率更低。
方法：治疗IV。
