Department of Orthopedic Surgery, The Third Hospital of Hebei Medical University, Hebei, China.
Department of Orthopedic Surgery, The Third Hospital of Hebei Medical University, Hebei, China.
Int J Surg. 2017 Jul;43:155-162. doi: 10.1016/j.ijsu.2017.05.069. Epub 2017 May 31.
An increasing number of meta-analyses comparing intramedullary fixation (IF) with plate fixation (PF) for displaced midshaft clavicle fracture have been reported, but the inconsistent results obtained might confuse decision-making. We systematically reviewed discordant meta-analyses for assisting the decision-maker in interpreting and selecting amongst discordant meta-analyses and providing surgical recommendations for displaced midshaft clavicle fracture according to currently best available evidence.
Meta-analyses on IF and PF for displaced midshaft clavicle fracture were identified by searching PubMed, Emabase and the Cochrane Library. A review of meta-analysis quality and data extraction was individually conducted by two reviewers. The meta-analysis providing the best available evidence was identified using the Jadad decision algorithm.
Nine studies were included, five of which were of Level-II evidence and four of which were of Level-III evidence. These meta-analyses scored from 6 to 10 according to the Assessment of Multiple Systematic Reviews instrument. With respect to the Jadad decision algorithm, the best meta-analysis was chosen depending upon publication characteristics and methodology of primary studies, language restrictions, and whether data on individual patients were analysed. A meta-analysis incorporating more randomised controlled trials was eventually selected. The best available evidence indicated that the differences between IF and PF were not significant in terms of shoulder function or the rate of treatment failure. However, IF significantly decreased the operative time and the rate of non-operative complications, especially the rate of infection.
Based on the best available evidence, IF may be superior to PF for treating displaced midshaft clavicle fracture.
越来越多的荟萃分析比较了髓内固定（IF）与钢板固定（PF）治疗移位型锁骨中段骨折，但结果的不一致可能会使决策变得复杂。我们系统地回顾了不一致的荟萃分析，以帮助决策者解释和选择不一致的荟萃分析，并根据当前最佳可用证据为移位型锁骨中段骨折提供手术建议。
通过搜索 PubMed、Emabase 和 Cochrane Library 来确定 IF 和 PF 治疗移位型锁骨中段骨折的荟萃分析。由两名评审员单独进行荟萃分析质量和数据提取的评估。使用 Jadad 决策算法确定提供最佳可用证据的荟萃分析。
共纳入 9 项研究，其中 5 项为 II 级证据，4 项为 III 级证据。这些荟萃分析按照评估多项系统评价工具的标准评分为 6 至 10 分。根据 Jadad 决策算法，最佳荟萃分析取决于出版物特征和原始研究方法、语言限制以及是否对个体患者的数据进行了分析。最终选择了纳入更多随机对照试验的荟萃分析。最佳可用证据表明，在肩功能或治疗失败率方面，IF 与 PF 之间没有显著差异。然而，IF 显著降低了手术时间和非手术并发症的发生率，特别是感染的发生率。
根据最佳可用证据，IF 可能优于 PF 治疗移位型锁骨中段骨折。
