髓内钉或克氏针与钢板固定治疗锁骨骨折的Meta分析

目的:系统评价髓内钉或克氏针与钢板固定比较治疗锁骨骨折的疗效和并发症。方法:计算机检索Pubmed、Embase、Cochrane数据库、中国期刊全文数据库(CNKI)、维普期刊数据库医药卫生辑(VIP)及万方数据库数据库。纳入比较髓内固定与髓外固定治疗锁骨骨折的前瞻性或随机随照研究。采用RevMan 5软件进行Meta分析,比较术后肩关节功能评分、手术疗效、手术指标及术后并发症率。结果:共纳入10篇随机对照研究、3篇半随机对照研究,合计976例纳入系统评价。5篇文献比较了克氏针与钢板的疗效,8篇文献比较了髓内钉与钢板的疗效。克氏针与钢板术后疗效优良率比值比(RR)3.7995%可信区间,1.93,7.46],6篇文献报告了髓内钉与钢板术后Constant评分,总体均数差为-1.39-3.43,0.65].5篇文献报告了髓内钉与钢板术后的大并发症率,RR为9.342.70,32.32].5篇文献比较了髓内钉与钢板的再手术率,RR为5.04 1.52,16.77].结论:现有研究证据表明髓内钉治疗锁骨骨折的术后并发症率及再手术率明显低于钢板;克氏针固定的术后疗效明显低于钢板固定。现有数据的总样本量有一定程度的局限性,期待未来大样本高质量随机对照试验进一步证明结果。

Treatment of clavicular fractures using intramedullary nailing or K-wire versus plating fixation:a meta-analysis

Objective:To compare the efficacy and complications rate of intramedullary (IM) nailing or K-wire versus plating fixation for clavicular fractures. Methods:Pubmed,Embase,Cochrane Library databases,CNKI,VIP and Wangfang databases were searched to find all randomized or quasi-randomized controlled trials of clavicle fractures using plating versus IM nailing or K-wire. The methodologic quality of the studies was assessed. After independent study selection by 2 authors,data were collected and extracted independently. Outcomes of postoperative shoulder functional measurement,the efficacy and information of the operation and complications rate were meta-analyzed using RevMan 5 software. Results:Nine hundreds and seventy-six patients in 10 randomized controlled trials (RCTs) and 3 quasi-RCTs were involved in the meta-analysis,of which 5 studies compared the K-wire and the plating fixations and 8 studies compared the IM nailing and the plating fixations. The overall odds ratio(OR)(with 95% CI) of the operation efficacy for K-wire versus the plating was 3.79 (1.93,7.46). The overall weighted mean difference (with 95% CI) of Constant Shoulder score for plating versus IM fixation was -1.39 (-3.43,0.65) in 6 studies. The overall OR of the plating versus IM nailing was 9.34(2.70,32.32) for the overall major complications in 5 studies and 5.04 (1.52,16.77) for the revision rate in 5 studies. Conclusion:The current limited evidences suggested that the IM fixation could reduce the incidences of the overall major complications and the revision surgery,while the post-operative efficacy of the plating was superior to the K-wire. More high quality RCTs are still needed in the future.