髓内钉与钢板内固定治疗成人移位型锁骨中段骨折的Meta分析

Intramedullary nail fixation versus plate fixation in the treatment of displaced midshaft clavicular fractures in adults:a meta-analysis

目的:目前有许多研究证明,髓内钉与钢板内固定是治疗移位型锁骨中段骨折较好的手术方式,但是关于2种手术方式的优缺点的对照研究相对较少,至今仍存在不少争议。文章通过对相关文献资料进行Meta分析,对髓内钉和钢板治疗成人移位型锁骨中段骨折的疗效和安全性进行系统评价。方法:通过计算机检索PubMed、Embase、Cochrane Library、知网、万方、VIP数据库,检索时间从建库到2020年1月,收集并筛选出符合纳入和排除标准的关于髓内钉与钢板内固定治疗锁骨中段骨折的随机对照试验文献,进行质量评价和资料提取,选择手术时间、切口长度、上肢功能评分、Constant-Murley评分、骨折愈合时间作为Meta分析的评价指标,使用RevMan 5.3软件对纳入研究结果进行Meta分析。结果:①共检索出8篇文献,其中283例患者采用髓内钉治疗,271例患者使用钢板内固定治疗;②Meta分析结果显示,在手术时间[MD=-19.63,95%CI(-22.72,-16.54)]、切口长度[MD=-3.31,95%CI(-5.78,-0.85)]、骨折愈合时间[MD=-1.53,95%CI(-2.73,-0.33)]方面髓内钉组均优于钢板组;③术后髓内钉组和钢板组在上肢功能评分[MD=-1.91,95%CI(-5.48,1.66)]、Constant-Murley评分[MD=-0.58,95%CI(-4.63,3.47)]方面差异无显著性意义。结论:Meta分析结果提示,与钢板内固定相比,髓内钉治疗移位型锁骨中段骨折在手术时间、切口长度和骨折愈合时间方面更具优势,可为临床使用髓内钉替代钢板内固定治疗移位型锁骨中段骨折提供证据。

OBJECTIVE:At present,many studies have proved that intramedullary nail and steel plate internal fixation is a better way to treat displaced midshaft clavicular fracture.However,there are relatively few comparative studies on the advantages and disadvantages of the two methods,and there are still many controversies.Through the meta-analysis of related literature,the efficacy and safety of intramedullary nail and steel plate in the treatment of adult displaced midshaft clavicular fracture were systematically evaluated.METHODS:Through computer retrieval of PubMed,Embase,Cochrane Library,CNKI,Wanfang and VIP databases from the inception to January 2020,the literature of randomized controlled trials meeting the inclusion and exclusion criteria of intramedullary nail and steel plate in the treatment of adult displaced midshaft clavicular fracture was collected and screened,and the quality evaluation and data extraction were carried out.The operation time,incision length and upper limb function score,Constant-Murley score,and fracture healing time were used as the evaluation indexes of meta-analysis.Meta-analysis was performed using ReMan 5.3 software.RESULTS:(1)Eight valuable articles were retrieved,among which 283 patients were treated with intramedullary nail and 271 patients were treated with steel plate internal fixation.(2)The meta-analysis results showed that the intramedullary nail group was superior to the steel plate group in terms of operation time[MD=-19.63,95%CI(-22.72,-16.54)],incision length[MD=-3.31,95%CI(-5.78,-0.85)],and fracture healing time[MD=-1.53,95%CI(-2.73,-0.33)].(3)No significant difference was found in upper limb function score[MD=-1.91,95%CI(-5.48,1.66)]and Constant-Murley score[MD=-0.58,95%CI(-4.63,3.47)between the intramedullary nail group and the steel plate group after surgery.CONCLUSION:The results of meta-analysis showed that intramedullary nail was superior to steel plate in the operation time,incision length and fracture healing time in the treatment of displaced midshaft clavicular fracture.The above results can provide evidence for clinical use of intramedullary nail instead of steel plate internal fixation in the treatment of displaced midshaft clavicular fracture.