保守治疗和切开复位钢板内固定治疗锁骨中段骨折的荟萃分析
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摘要
[目的]通过荟萃分析比较保守治疗和切开复位钢板内固定治疗锁骨中段骨折的临床疗效。[方法]计算机检索2000年1月～2018年10月PubMed、The Cochrane Library、EMbase、MEDLINE(Ovid)、CBM、CNKI和万方医学数据库,搜索保守与切开复位钢板内固定治疗成人锁骨中段骨折的随机对照试验,严格按照纳入和排除标准及文献质量评分标准收集数据,采用RevMan 5.3统计学软件对所提取的文献数据进行荟萃分析。[结果]共纳入9篇文献,共计1 111例患者。荟萃分析显示:锁骨中段骨折的两种治疗方案在术后1年的DASH无明显差别[MD=3.58,95%CI(-0.49,7.65),P=0.08],但钢板内固定组在术后1年的Constant评分略有优势[MD=-3.53,95%CI(-6.92,-0.15),P=0.04];此外,钢板内固定可使骨不连[RR=8.51,95%CI(4.50,16.07),P<0.001]及二次手术[RR=3.22,95%CI(2.12,4.90),P<0.001]发生率显著降低。[结论]目前证据显示,切开复位钢板内固定治疗锁骨中段骨折术后1年的功能优于保守治疗,并明显降低骨不连及二次手术发生率。
[Objective] To compare the clinical outcomes of non-operative versus open reduction and internal fixation(ORIF) for midshaft clavicle fractures. [Methods] Published studies about the clinical results of non-operative versus ORIF treatment for midshaft clavicle fractures were searched during January 2000 to October 2018 on the PubMed, Cochrane Library, EMbase, MEDLINE(Ovid), CBM, CNKI and WanFang Medical Data to collect randomized controlled trials(RCTs). A meta-analysis was conducted using Revman 5.3 software. [Results] A total of 9 RCTs meeting criteria were identified from the literature review. The results of meta-analysis showed that ORIF was superior to nonoperation in the Constant score after one year [MD=-3.53, 95% CI(-6.92,-0.15), P=0.04], the rate of nonunion [RR=8.51, 95%CI(4.50, 16.07), P<0.001] and the rate of secondary operations [RR=3.22, 95% CI(2.12, 4.90), P<0.001]. However, there were no significant difference in the DASH scores[MD=3.58, 95% CI(-0.49, 7.65), P=0.08]. [Conclusions] For patients with a midshaft fracture of the clavicle, ORIF improves the rate of nonunion, secondary operations and the function of the upper limb.
[Objective] To compare the clinical outcomes of non-operative versus open reduction and internal fixation(ORIF) for midshaft clavicle fractures. [Methods] Published studies about the clinical results of non-operative versus ORIF treatment for midshaft clavicle fractures were searched during January 2000 to October 2018 on the PubMed, Cochrane Library, EMbase, MEDLINE(Ovid), CBM, CNKI and WanFang Medical Data to collect randomized controlled trials(RCTs). A meta-analysis was conducted using Revman 5.3 software. [Results] A total of 9 RCTs meeting criteria were identified from the literature review. The results of meta-analysis showed that ORIF was superior to nonoperation in the Constant score after one year [MD=-3.53, 95% CI(-6.92,-0.15), P=0.04], the rate of nonunion [RR=8.51, 95%CI(4.50, 16.07), P<0.001] and the rate of secondary operations [RR=3.22, 95% CI(2.12, 4.90), P<0.001]. However, there were no significant difference in the DASH scores[MD=3.58, 95% CI(-0.49, 7.65), P=0.08]. [Conclusions] For patients with a midshaft fracture of the clavicle, ORIF improves the rate of nonunion, secondary operations and the function of the upper limb.
引文
[1]Postacchini F,Gumina S,De Santis P,et al.Epidemiology of clavicle fractures[J].J Shoulder Elbow Surg,2002,11(5):452-456.
[2]Kihlstrom C,Moller M,Lonn K,et al.Clavicle fractures:epidemiology,classification and treatment of 2 422 fractures in the Swedish Fracture Register:an observational study[J].BMC Musculoskelet Disord,2017,18(1):82.
[3]李国珅,查晔军,蒋协远.锁骨中段骨折的治疗现状[J].中国矫形外科杂志,2017,25(16):1486-1489.
[4]Lenza M,Faloppa F.Conservative interventions for treating middle third clavicle fractures in adolescents and adults[J].Cochrane Database Syst Rev,2016,12:Cd007121.
[5]孙伟桐,查晔军,蒋协远.锁骨中段骨折的治疗选择[J].中华肩肘外科电子杂志,2018,6(1):68-72.
[6]李浪,陈龙,邢飞,等.手术与非手术治疗锁骨中段骨折的Meta分析[J].中国循证医学杂志,2018,18(5):489-497.
[7]Woltz S,Krijnen P,Schipper IB.Plate fixation versus nonoperative treatment for displaced midshaft clavicular fractures:a meta-analysis of randomized controlled trials[J].J Bone Joint Surg Am,2017,99(12):1051-1057.
[8]Ahrens PM,Garlick NI,Barber J,et al.The clavicle trial:a multicenter randomized controlled trial comparing operative with nonoperative treatment of displaced midshaft clavicle fractures[J].JBone Joint Surg Am,2017,99(16):1345-1354.
[9]Tamaoki MJS,Matsunaga FT,Costa A,et al.Treatment of displaced midshaft clavicle fractures:figure-of-eight harness versus anterior plate osteosynthesis:a randomized controlled trial[J].JBone Joint Surg Am,2017,99(14):1159-1165.
[10]Woltz S,Stegeman SA,Krijnen P,et al.Plate fixation compared with nonoperative treatment for displaced midshaft clavicular fractures:a multicenter randomized controlled trial[J].J Bone Joint Surg Am,2017,99(2):106-112.
[11]Qvist AH,Vaesel MT,Jensen CM,et al.Plate fixation compared with nonoperative treatment of displaced midshaft clavicular fractures:a randomized clinical trial[J].Bone Joint J,2018,100-b(10):1385-1391.
[12]Society COT.Nonoperative treatment compared with plate fixation of displaced midshaft clavicular fractures.A multicenter,randomized clinical trial[J].J Bone Joint Surg Am,2007,89(1):1-10.
[13]Mirzatolooei F.Comparison between operative and nonoperative treatment methods in the management of comminuted fractures of the clavicle[J].Acta Orthop Traumatol Turc,2011,45(1):34-40.
[14]Virtanen KJ,Remes V,Pajarinen J,et al.Sling compared with plate osteosynthesis for treatment of displaced midshaft clavicular fractures:a randomized clinical trial[J].J Bone Joint Surg Am,2012,94(17):1546-1553.
[15]Robinson CM,Goudie EB,Murray IR,et al.Open reduction and plate fixation versus nonoperative treatment for displaced midshaft clavicular fractures:a multicenter,randomized,controlled trialv[J].Bone Joint Surg Am,2013,95(17):1576-1584.
[16]Melean PA,Zuniga A,Marsalli M,et al.Surgical treatment of displaced middle-third clavicular fractures:a prospective,randomized trial in a working compensation population[J].J Shoulder Elbow Surg,2015,24(4):587-592.
[17]Hozo SP,Djulbegovic B,Hozo I.Estimating the mean and variance from the median,range,and the size of a samplev[J].BMC Med Res Methodol,2005,5(1):13.
[18]杨阳,王亚薇,马剑雄,等.非手术治疗锁骨中段骨折不愈合的风险因素分析[J].中国矫形外科杂志,2015,23(22):2067-2069.
[2]Kihlstrom C,Moller M,Lonn K,et al.Clavicle fractures:epidemiology,classification and treatment of 2 422 fractures in the Swedish Fracture Register:an observational study[J].BMC Musculoskelet Disord,2017,18(1):82.
[3]李国珅,查晔军,蒋协远.锁骨中段骨折的治疗现状[J].中国矫形外科杂志,2017,25(16):1486-1489.
[4]Lenza M,Faloppa F.Conservative interventions for treating middle third clavicle fractures in adolescents and adults[J].Cochrane Database Syst Rev,2016,12:Cd007121.
[5]孙伟桐,查晔军,蒋协远.锁骨中段骨折的治疗选择[J].中华肩肘外科电子杂志,2018,6(1):68-72.
[6]李浪,陈龙,邢飞,等.手术与非手术治疗锁骨中段骨折的Meta分析[J].中国循证医学杂志,2018,18(5):489-497.
[7]Woltz S,Krijnen P,Schipper IB.Plate fixation versus nonoperative treatment for displaced midshaft clavicular fractures:a meta-analysis of randomized controlled trials[J].J Bone Joint Surg Am,2017,99(12):1051-1057.
[8]Ahrens PM,Garlick NI,Barber J,et al.The clavicle trial:a multicenter randomized controlled trial comparing operative with nonoperative treatment of displaced midshaft clavicle fractures[J].JBone Joint Surg Am,2017,99(16):1345-1354.
[9]Tamaoki MJS,Matsunaga FT,Costa A,et al.Treatment of displaced midshaft clavicle fractures:figure-of-eight harness versus anterior plate osteosynthesis:a randomized controlled trial[J].JBone Joint Surg Am,2017,99(14):1159-1165.
[10]Woltz S,Stegeman SA,Krijnen P,et al.Plate fixation compared with nonoperative treatment for displaced midshaft clavicular fractures:a multicenter randomized controlled trial[J].J Bone Joint Surg Am,2017,99(2):106-112.
[11]Qvist AH,Vaesel MT,Jensen CM,et al.Plate fixation compared with nonoperative treatment of displaced midshaft clavicular fractures:a randomized clinical trial[J].Bone Joint J,2018,100-b(10):1385-1391.
[12]Society COT.Nonoperative treatment compared with plate fixation of displaced midshaft clavicular fractures.A multicenter,randomized clinical trial[J].J Bone Joint Surg Am,2007,89(1):1-10.
[13]Mirzatolooei F.Comparison between operative and nonoperative treatment methods in the management of comminuted fractures of the clavicle[J].Acta Orthop Traumatol Turc,2011,45(1):34-40.
[14]Virtanen KJ,Remes V,Pajarinen J,et al.Sling compared with plate osteosynthesis for treatment of displaced midshaft clavicular fractures:a randomized clinical trial[J].J Bone Joint Surg Am,2012,94(17):1546-1553.
[15]Robinson CM,Goudie EB,Murray IR,et al.Open reduction and plate fixation versus nonoperative treatment for displaced midshaft clavicular fractures:a multicenter,randomized,controlled trialv[J].Bone Joint Surg Am,2013,95(17):1576-1584.
[16]Melean PA,Zuniga A,Marsalli M,et al.Surgical treatment of displaced middle-third clavicular fractures:a prospective,randomized trial in a working compensation population[J].J Shoulder Elbow Surg,2015,24(4):587-592.
[17]Hozo SP,Djulbegovic B,Hozo I.Estimating the mean and variance from the median,range,and the size of a samplev[J].BMC Med Res Methodol,2005,5(1):13.
[18]杨阳,王亚薇,马剑雄,等.非手术治疗锁骨中段骨折不愈合的风险因素分析[J].中国矫形外科杂志,2015,23(22):2067-2069.