Department of Orthopaedics, West China Hospital, Sichuan University, Chengdu, China.
J Shoulder Elbow Surg. 2011 Sep;20(6):1008-15. doi: 10.1016/j.jse.2011.01.018. Epub 2011 Apr 9.
Clavicular fractures account for 2% to 2.6% of all fractures. Plating has been considered the gold standard for treating midshaft clavicular fracture. Intramedullary pinning and conservative treatments have also been commonly used. We hypothesized that intramedullary pinning and conservative treatments have the same treatment results compared with plating.
To evaluate the effect of plating vs intramedullary pinning or conservative treatment for midshaft clavicular fracture, the Cochrane Central Register of Controlled Trials (CENTRAL; Wiley Online Library, October 2010), PubMed (1950 to October 2010), and EMBASE (1980 to October 2010) were searched. Randomized and quasi-randomized controlled clinical studies evaluating plating vs intramedullary pinning or plating vs conservative treatment for midshaft clavicular fracture in adults were collected. After independent study selection by 2 authors, data were collected and extracted independently. The methodologic quality of the studies was assessed. Pooling of data was undertaken.
Four studies involving 305 clavicular fractures were included. There were no significant differences between plating and intramedullary pinning with regard to outcome for Oxford Shoulder Score, Constant Shoulder Score, nonunion, infection, fixation failure, and hardware removal. More symptomatic hardware events occurred with plating compared with intramedullary pinning. Reduced nonunion, malunion, and neurologic symptoms, as well as more satisfaction with ultimate appearance, were associated with plating than with conservative treatment.
This meta-analysis supports the treatment effects reported previously with plating for midshaft clavicular fractures. The outcome of this meta-analysis contradicted the findings reported previously with conservative treatment for midshaft clavicular fractures.
The available evidence suggests that there are no differences in treatment effects between plating and intramedullary pinning, but plating is associated with more side effects. Plating is associated with improved treatment effects when compared with conservative treatment.
锁骨骨折占所有骨折的 2%至 2.6%。钢板固定被认为是治疗锁骨中段骨折的金标准。髓内钉固定和保守治疗也常被使用。我们假设髓内钉固定和保守治疗与钢板固定的治疗效果相同。
为了评估钢板与髓内钉固定或保守治疗治疗锁骨中段骨折的效果，我们检索了 Cochrane 中央对照试验注册库（CENTRAL；Wiley Online Library，2010 年 10 月）、PubMed（1950 年至 2010 年 10 月）和 EMBASE（1980 年至 2010 年 10 月）。收集了评估成人锁骨中段骨折钢板与髓内钉固定或钢板与保守治疗的随机和准随机对照临床试验。两名作者独立进行研究选择、数据收集和提取。评估了研究的方法学质量。进行了数据合并。
纳入了四项涉及 305 例锁骨骨折的研究。钢板与髓内钉固定在牛津肩部评分、常数肩部评分、不愈合、感染、固定失败和硬件去除等方面的结果没有显著差异。与髓内钉固定相比，钢板固定更容易发生有症状的硬件事件。与保守治疗相比，钢板固定可降低不愈合、畸形愈合和神经症状的发生率，以及对最终外观的满意度更高。
这项荟萃分析支持了以前关于钢板治疗锁骨中段骨折的治疗效果报告。这项荟萃分析的结果与以前关于保守治疗锁骨中段骨折的报告结果相矛盾。
现有证据表明，钢板与髓内钉固定在治疗效果上没有差异，但钢板固定的副作用更多。与保守治疗相比，钢板固定可改善治疗效果。
