成人锁骨中段骨折手术治疗与非手术治疗的Meta分析

Comparing the effect of operative and nonoperative treatment in adult mid-shaft clavicular fracture by Meta-analysis

目的 应用Meta分析系统总结评价手术治疗与非手术治疗在成人锁骨中段骨折中的疗效及相关优势.方法 通过检索1989至2009年间Cochrane Database、Pub med ＆ Ovid Medline、OTA、AAOS、High Wire Press、Springer Link、中国生物医学文献数据库、中国知网和万方数据库,并且配合手工检索相关领域的杂志,纳入以成人锁骨中段骨折为研究对象,比较手术治疗与非手术治疗的随机对照实验及回顾性队列研究,评价纳入研究质量,并用Rvaman 4.2进行Meta分析.结果 经过筛选初检文献5053篇,共纳入8个研究（519例患者）.共有5个研究选用骨折愈合率作为观察指标,结果P＜0.00001;4个研究选用畸形愈合率作为观察指标,结果P＜0.0001;5个研究选用神经刺激症状作为观察指标,结果P＜0.0001;4个研究选用患者满意度作为观察指标,结果P＜0.00001;4个研究选用残余痛作为观察指标,结果P=0.56;2个研究选用关节活动障碍作为观察指标,结果P=0.25;3个研究选用再骨折作为观察指标,研究不存在异质性,结果P＞0.05.结论 系统评价的结果表明,手术治疗成人锁骨中段骨折较非手术治疗存在优势.

Objective To systematically summarize and compare results and related advantages of different methods in the management of adult mid-shaft clavicle fractures. Methods The data of adult midshaft clavicle fracture from 1989 to 2009 was retrieved. The database were included Cochrane Database,med ＆ Ovid Medline, OTA, AAOS, High Wire Press, Springer Link, CBM, CNKI, WANFANG DATA and with hand-search journals in related fields. Internalizing randomized controlled trials and retrospective cohort studies which compared the operative and nonoperative treatment for adult mid-shaft clavicle fracture. Evaluating the quality of included studies and using the Rvaman 4.2 for Meta-Analysis. Results 5053 literatures had been reviewed. After screening, there were 8 studies brought into the review that included 519 patients.There were 5 studies which took union rate as observed indicator. The results had statistically significant （P〈0.00001）. A total of 4 studies used malunion rate as indicator, the results had statistically significant （P 〈0.0001）. A total of 4 researches selected satisfaction of patient as indicator, the results had statistically significant（P〈0.00001）. A total of 5 studies selected symptoms of nerve stimulation as indicator, the results had statistically significant （P〈0.0001）. A total of 4 studies selected residual pain as indicator, the results had no significant statistically difference （P=0.56）. A total of 2 studies selected barriers of joint activities as indicator, the results had no significant statistically difference （P=0.25）. A total of 2 researches used refracture as indicator, the results had no significant statistically difference （P〉O.05）. Conclusion This study evaluation results shows that operation can be used as the first choice of treatment of adult midshaft clavicle fractures.