切开复位接骨板内固定与非手术治疗成人锁骨中段骨折的疗效及安全性系统评价

Systematic review on the curative effect and safety of open reduction and interal fixation with bone plate versus nonoperative treatment for treatment of middle clavicular fractures in adults

目的:系统评价和对比切开复位接骨板内固定与非手术治疗成人锁骨中段骨折的疗效及安全性。方法:通过计算机检索The Cochrane Library(2016年第5期)、Pub Med、Embase、High Wire Press、Springer Link、CNKI、CBM、Wan Fang Data建库至2016年5月国内外公开发表的所有切开复位接骨板内固定(接骨板固定组)与非手术(非手术组)治疗成人锁骨中段骨折的随机对照试验文献,同时手工检索本专业相关期刊从1990年1月至2016年5月的所有相关文献。由2位评价员独立对检索到的文献进行筛选与质量评价,采用Cochrane协作网提供的Revman5.2.5软件进行Meta分析。结果:共检出文献516篇,经逐层筛选最终纳入4篇英文文献,均为随机对照试验文献,共涉及390例患者,其中接骨板固定组200例、非手术组190例。Meta分析结果显示,治疗后接骨板固定组的Constant评分和DASH评分均优于非手术组[WMD=3.26,95%CI(0.45,6.06);WMD=-2.72,95%CI(-4.99,-0.44)],非手术组骨折不愈合率和骨折畸形愈合率均高于接骨板固定组[RR=0.14,95%CI(0.05,0.37);RR=0.15,95%CI(0.06,0.33)]。结论:与非手术治疗相比,采用切开复位接骨板内固定治疗成人锁骨中段骨折,患者上肢及肩关节功能恢复更好,骨折不愈合和畸形愈合的发生率更低。

Objective：To systematically evaluate and compare the curative effect and safety of open reduction and interal fixation with bone plate versus nonoperative treatment for treatment of middle clavicular fractures in adults.Methods：All the randomized controlled trial（RCT） articles about open reduction and interal fixation with bone plate（bone plate fixation group） versus nonoperative treatment（nonoperative group） for treatment of middle clavicular fractures in adults that published at home and abroad included from database establishing to May2016 were retrieved from the Cochrane Library（2016,No.5）,Pub Med,Embase,High Wire Press,Springer Link,China national knowledge internet,CBM and Wan Fang Data through computer.Meanwhile,all the relevant articles published in relevant orthopedic journals included from January 1990 to May 2016 were manual retrieved.The acquired articles were screened and the quality of research in the articles was evaluated independently by two assessors.A Meta-analysis was conducted by using Revman 5.2.5 software provided by Cochrane Collaboration.Results：Five hundred and sixteen articles were searched out.After screening,4 English articles（RCT） were included in the final analysis,200 patients in bone plate fixation group and 190 patients in nonoperative group.The result of Meta-analysis demonstrated that bone plate fixation group surpassed nonoperative group in Constant scores and DASH scores after the treatment[WMD=3.26,95% CI（0.45,6.06）;WMD=-2.72,95% CI（-4.99,-0.44） ] and the fracture nonunion rate and fracture malunion rate were higher in nonoperative group compared to bone plate fixation group（RR=0.14,95% CI（0.05,0.37）;RR=0.15,95% CI（0.06,0.33））.Conclusion：Better functional recovery of upper limbs and shoulder joints and lower incidence rates of fracture nonunion and fracture malunion can be obtained by open reduction and interal fixation with bone plate compared to nonoperative therapy in the treatment of middle clavicular fractures in adults.