锁骨骨折植入物内固定与保守治疗效果比较的Meta分析

摘要

背景：关于锁骨骨折选择植入物内固定亦或保守治疗，目前尚存争议。　　目的：以Meta分析方法探讨植入物内固定治疗和保守治疗对锁骨骨折疗效的影响。　　方法：在PUBMED、EMBASE、OVID、Cochrane图书馆、Science Direct、Springer Link、中文学术期刊全文数据库(CNKI)和万方医学网中检索2000年1月到2013年12月有关锁骨骨折治疗方面的文献，按照特定的纳入和排除标准筛选，对所选文献进行质量评价，并提取所需的原始数据，用Review Manager 5.0软件进行Meta分析。　　结果与结论：共纳入6篇随机对照研究，共570例患者。Meta分析结果表明，对于锁骨骨折，植入物内固定治疗可以降低骨不连率[RR=0.16，95%CI(0.07，0.38)，P <0.0001]、畸形愈合率[RR=0.15，95%CI(0.07，0.34)，P <0.00001]、延迟愈合率[RR=0.20，95%CI(0.06，0.70)，P=0.01]及治疗后1年残余疼痛发生率[RR=0.24，95%CI(0.12，0.51)，P=0.0002]，可以提高Constant Score(CS)评分[MD=3.68，95%CI(1.61，5.76)，P=0.0005]，然而尚不能认为内固定治疗可以降低神经并发症发生率[RR=0.63，95%CI(0.06，0.70)， P=0.22]。提示在锁骨骨折的治疗方面，植入物内固定治疗能够取得较好的临床效果。但是由于所选文献还有一定的局限性，尚需高质量的多中心随机对照试验进一步验证结论。故在临床上选择锁骨骨折治疗方法时，仍需根据患者的自身情况来决定。%BACKGROUND:It is stil disputed at present about the treatment selection for clavicle fractures, operative or conservative treatment. OBJECTIVE:To evaluate the effects of operative and non-operative (conservative) treatment for clavicle fractures with the method of meta-analysis. METHODS: We retrieved PUBMED, EMBASE, OVID, Cochrane library, Science Direct, Springer Link, China National Knowledge Infrastructure and Wanfang Database for articles on treatment of clavicle fractures published from January 2000 to December 2013. According to specific inclusion and exclusion criteria, relevant literatures about treatments of clavicle fractures were searched for data source extraction, which were used for meta-analysis using Review Manager 5.0 software. RESULTS AND CONCLUSION:Six randomized controled trials were included, including 570 patients. Meta-analysis results demonstrated that for clavicle fractures, implant fixation could decrease nonunion rate [RR=0.16, 95%CI(0.07, 0.38),P < 0.000 1], malunion rate [RR=0.15, 95%CI(0.07, 0.34),P < 0.000 01], delayed union rate [RR=0.20, 95%CI(0.06, 0.70),P=0.01] and the incidence of residual pain at 1 year after treatment [RR=0.24, 95%CI(0.12, 0.51),P=0.000 2], could elevate Constant Score [MD=3.68, 95%CI(1.61, 5.76),P=0.000 5]. However, it was not concluded that fixation could reduce the incidence of neurological complications [RR=0.63, 95%CI(0.06, 0.70),P=0.22]. It is suggested that implant fixation for clavicle fractures obtained good clinical effects. However, due to the disadvantages of the included literatures, we stil needed high-quality multicenter randomized controled trials to further verify conclusions, and should pay more attention on patients’ individual conditions when the therapeutic methods for clavicle fractures were selected in the clinic.