钛制弹性髓内钉与接骨板内固定治疗成人移位型锁骨中段骨折的Meta分析

Titanium Elastic Intramedullary Nail and Plate Internal Fixation for Treating Displaced Midshaft Clavicular Fractures in Adults: a Meta-analysis

目的:系统评价应用钛制弹性髓内钉与接骨板内固定治疗成人移位型锁骨中段骨折的疗效。方法:计算机检索Pub Med、The Cochrane Library、EMbase、CBM、CNKI、VIP和Wan Fang Data数据库,搜集应用钛制弹性髓内钉与接骨板内固定治疗成人移位型锁骨中段骨折疗效对比的随机对照试验,检索时限从建库到2015年11月10日。2位评价员按纳入与排除标准筛选文献、提取数据和评价质量,采用Rev Man5.3软件进行Meta分析。结果:纳入5个随机对照试验,361例成年单侧移位型锁骨中段移位骨折患者。Meta分析结果显示:接骨板术后ContantMurley肩关节功能评分较高(MD=-1.87,95%CI=-2.24^-1.49),DASH上肢功能评分较好(MD=1.49,95%CI=1.18~1.81),由内固定物引起的皮肤刺激或疼痛的发生率较低(RR=1.81,95%CI=1.30~2.50),而钛制弹性髓内钉手术切口小(MD=-4.94,95%CI=-6.41^-3.47),出血量小(MD=-58.97,95%CI=-82.63^-35.30),术后感染率低(RR=0.27,95%CI=0.08~0.96),骨折愈合时间短(MD=-1.24,95%CI=-2.26^-0.22),术后增生性瘢痕少(RR=0.17,95%CI=0.03~0.94),两组内固定物失败率及再骨折发生率无明显差异(RR=1.83,95%CI=0.38~8.79;RR=0.38,95%CI=0.11~1.37)。结论:当前证据显示,钛制弹性髓内钉具有微创、美观、骨折愈合快等优点,但接骨板内固定治疗成人移位型锁骨中段骨折肢体功能恢复得更好。受纳入研究数量和质量限制,上述结论尚需进一步验证。建议对复杂移位型锁骨中段骨折采用接骨板内固定,简单移位型锁骨中段骨折采用弹性髓内钉内固定。

Objective To systematically review the effects of titanium elastic intramedullary nail and plate internal fixation for treatment of displaced midshaft clavicular fractures in adults. Methods We ＇electronically searched PubMed, The Cochrane Library,Embase,CBM,CNKI, VIP and Wanfang databases from inception to November 10th 2015, to collect randomized controlled trials（RCTs） of TEN and plate internal fixation for treating displased midshaft clavicular fractures in adults.Two reviewers screened literatures according to the inclusion and exclusion criteria, extracted data and assessed the risk of bias of included studies. Metaanalysis was performed using RevMan 5.3 software. Results Total 5 RCTs including 361 patients were involved in this Meta-analysis.The results of bleta-analysis indicated that the Contant-Murley score of shoulder joint function was higher in patients underwent plate operation（ MD =- 1.87,95%CI=-2.24-- 1.49 ） ,the DASH score of upper limb function was better（ MD = 1.49,95%CI = 1.18 ~ 1.81 ） ,the incidence of skin irritation or pain induced by internal fixa- tion plate was lower（ RR = 1.81,95% CI = 1.30 - 2.50） , but in patients underwent titanium elastic intramedullary nail, the surgical incision and bleeding were smaller（ MD = - 4.94,95% CI = - 6.41 - - 3.47 ; MD = - 58.97,95% CI = - 82.63 - - 35.30）, the infection rate was lower（ RR = 0.27,95%CI = 0.08- 0.96） , the fracture healing time was shorter（ MD =- 1.24,95%CI =-2.26--0.22） and with less postoperative scar（ RR= 0.17,95%CI = 0.03-0.94） ,the incidences of internal fixation failure and refracture had no differences between two operations （RR = 1.83,95%CI = 0.38- 8.79; RR = 0.38,95% CI = 0.11 - 1.37） .Conclusion Current evidence shows that titanium elastic intramedullary nail has the advantages of minimal invasion, beautiful appearance and fast fracture healing, but plate internal fixation has better limb function recovery in treating displased midshaft clavicular fractures in adults.Due to the limited quality and quantity of including studies ,more high quality studies are needed to verify the above conclusion.Titanium elastic intraMedullary nail are recommended for simple displaced midshaft clavicular fractures and plates for complicated displaced midshaft clavicular fractures.