髓内钉与钢板内固定治疗移位型锁骨中段骨折疗效比较的Meta分析

Intramedullary pin versus plate for treatment of displaced mid-shaft clavicle fractures： a meta-analysis

目的 通过Meta分析比较髓内钉与钢板内固定治疗移位型锁骨中段骨折的疗效. 方法 根据Cochrane系统评价方法,计算机检索PubMed、CENTRAL、中国生物医学文献数据库等,手工检索本专业相关杂志,检索时间为建库至2013年12月,收集所有比较髓内钉与钢板内固定治疗移位型锁骨中段骨折疗效的随机对照试验（RCTs）与临床对照试验（CCTs）.对纳入研究的文章质量采用修订后的Jadad量表进行评分,并提取有效数据（切口长度、术中失血量、手术时间、住院时间、切口感染率、内固定不适感发生率、内固定不良事件发生率、骨折延迟愈合发生率、骨折畸形愈合发生率、骨折不愈合发生率、总体并发症发生率及Constant评分等）采用RevMan5.2.7软件进行Meta分析. 结果 共纳入3篇RCTs和7篇CCTs,共697例患者.改良的Jadad量表评定文献质量相对较高.Meta分析结果显示：髓内钉组在切口长度、术中失血量、手术时间、住院时间、切口感染及内固定不适感的发生率方面均优于钢板组,差异均有统计学意义（P＜0.05）;但髓内钉组内固定不良事件发生率显著高于钢板组,差异有统计学意义（P＜0.05）;两组在骨折延迟愈合、骨折不愈合、骨折畸形愈合、Constant评分及总体并发症发生率方面差异均无统计学意义（P＞0.05）. 结论 与钢板内固定相比,髓内钉固定治疗移位型锁骨中段骨折更具微创性,具有手术切口小、术中失血量少、手术和住院时间短、切口感染率低和内固定刺激不适症状发生率低等微创手术的优点.髓内钉组出现内固定不良事件的发生率高于钢板组,但术后骨折愈合及Constant评分两组间均无显著差异.

Objective To compare the clinical efficacy of intramedullary pin versus plate fixation for displaced mid-shaft clavicle fractures.Methods The databases,PubMed,CENTAL and CBM,were searched according to the standards of the Cochrane Collaboration for all the randomized controlled trials （RCTs） and clinical controlled trials （CCTs） comparing intramedullary pin with plate fixation for treatment of displaced mid-shaft clavicle fractures.In addition,hand search was also conducted in relevant journals.Time limit for search was from the beginning till December 2013.Trial quality was assessed using the modified Jadad scale and effective data were pooled for Meta analysis with software RevMan5.2.7,including wound infection,hospital stay,wound size,intraoperative blood loss,operation duration,implant irritation,implant problems,delayed union,malunion,nonunion,total complications and Constant scoring.Results Three RCTs and 7 CCTs with 697 patients were included in our study.The modified Jadad scoring showed fine quality of the 10 trials.Intramedullary fixation was significantly superior to plate fixation in wound size,intraoperative blood loss,operation duration,hospital stay,wound infection,and symptomatic hardware （P ＜ 0.05）,but led to a significantly higher rate of implant problems （P ＜ 0.05）.However,no significant differences were identified in total complication rate,delayed union,nonunion,malunion or Constant score （P ＞ 0.05）.Conclusions The superiority of intramedullary fixation for displaced mid-shaft clavicle fracture lies in its advantages of minimally invasion,such as limited incision,less intraoperative bleeding,shorter operation time and hospital stay,less wound infection and implant irritation.Ahhough intramedullary fixation may lead to a higher rate of implant problems,it shows no significant differences from plate fixation in bone healing and functional recovery.