目的本系统评价总结了有关肩胛骨间韧带(pSLIL)部分损伤的治疗选择和预后的现有证据。方法对Medline进行系统的电子搜索,Embase,和CINAHL从成立到2022年2月13日进行。无论手术时机如何,所有涉及pSLIL眼泪治疗的主要研究文章均有资格纳入。外科技术,或康复。PRISMA清单指导了报告和数据抽象。提供了描述性统计数据和森林地块。结果共纳入14项研究,342例患者进行分析。治疗分为四组:电热收缩(ES),关节镜下囊成形术(AC),开放式囊袋(OC),没有治疗(NT)。ES组有5项研究(N=69,平均年龄=34.3±3.3岁),AC组的三项研究(N=138,平均年龄=32.2±3.8岁),OC组的五项研究(N=123,平均年龄30.7±7.8岁),NT组的一项研究(N=12,平均年龄=43岁,范围=28-67年)。ES组干预后视觉模拟疼痛评分平均为1.4±0.5(5.7±1.8),AC组为3.2±1.3(从6.6±0),OC组为2.3±2.1(从5.6±1.6),NT组为3.2(从7.6)。所有干预组术后腕关节伸展运动范围均有改善(ES=66.3°-70.7°;AC=67°-74.5°;OC=48.9°-63.5°),而NT组保持不变(46°-45°)。所有干预组的握力也得到改善(ES=17.9-29.9kg;AC=24.0-32.2kg;OC=15.8-26.6kg),而NT组保持不变(25-24kg)。在所有报告干预前和干预后的组(ES=2.2-1.9mm;OC=2.5-1.8mm)中,放射学上的肩胛骨间隙均在术后改善,而NT组(2.5-2.7mm)中略有恶化。在ES组中,有三种并发症(11.5%,无重大并发症),在AC组有一个主要并发症(0.9%,复杂区域疼痛综合征[CRPS]),OC组有6种并发症(15.4%,四大并发症-CRPS)。结论所有介入治疗方案(ES,AC,和OC)在患者报告的疼痛方面提供了显着改善,运动范围,握力,和射线照相参数,并发症发生率低。相比之下,NT组的运动范围或握力没有改善.因此,手术治疗pSLIL损伤是一种有效且相对安全的治疗选择.需要进一步研究比较特定手术治疗的结果,以进一步阐明pSLIL眼泪的最佳管理选择。证据等级III级,系统评价III-IV级研究。
Purpose This systematic review summarizes the existing evidence on treatment options and outcomes for partial
scapholunate interosseous ligament (pSLIL) injuries. Methods A systematic electronic search of Medline, Embase, and CINAHL was performed from inception through to February 13, 2022. All primary research articles addressing the treatment of pSLIL tears were eligible for inclusion regardless of timing of surgery, surgical technique, or rehabilitation. The PRISMA Checklist guided the reporting and data abstraction. Descriptive statistics and forest plots are presented. Results A total of 14 studies with 342 patients were included for analysis. Treatments were categorized into four groups: electrothermal shrinkage (ES), arthroscopic capsuloplasty (AC), open capsulodesis (OC), and no treatment (NT). There were five studies in the ES group ( N = 69, mean age = 34.3 ± 3.3 years), three studies in the AC group ( N = 138, mean age = 32.2 ± 3.8 years), five studies in the OC group ( N = 123, mean age of 30.7 ± 7.8 years), and one study in the NT group ( N = 12, mean age = 43 years, range = 28-67 years). The average postintervention visual analog scale pain score for the ES group was 1.4 ± 0.5 (from 5.7 ± 1.8), for the AC group was 3.2 ± 1.3 (from 6.6 ± 0), for the OC group was 2.3 ± 2.1 (from 5.6 ± 1.6), and for the NT group was 3.2 (from 7.6). The wrist extension range of motion improved postoperatively for all intervention groups (ES = 66.3°-70.7°; AC = 67°-74.5°; and OC = 48.9°-63.5°), whereas it remained unchanged for the NT group (46°-45°). Grip strength also improved in all intervention groups (ES = 17.9-29.9 kg; AC = 24.0-32.2 kg; and OC = 15.8-26.6 kg), while the NT group remained unchanged (25-24 kg). The radiographic
scapholunate gap improved postoperatively in all groups that reported pre- and postintervention (ES = 2.2-1.9 mm; OC = 2.5-1.8 mm) and slightly worsened in the NT group (2.5-2.7 mm). In the ES group, there were three complications (11.5%, no major complications), in the AC group there was one major complication (0.9%, complex regional pain syndrome [CRPS]), and in the OC group there were six complications (15.4%, four major complications-CRPS). Conclusion All interventional treatment options (ES, AC, and OC) provided significant improvements in patient-reported pain, range of motion, grip strength, and radiographic parameters, with low complication rates. In comparison, no improvement in range of motion or grip strength was noted in the NT group. Therefore, surgical management of pSLIL injuries is an effective and relatively safe treatment option. Further studies comparing the outcomes of specific surgical treatments are warranted to further elucidate the optimal management option for pSLIL tears. Level of Evidence Level III, systematic review of Level III-IV studies.