Orthopaedic Surgery Department, Hamad General Hospital, Doha, Qatar.
J Orthop Trauma. 2018 Jul;32(7):e276-e283. doi: 10.1097/BOT.0000000000001174.
To compare open reduction and internal fixation (ORIF) and nonsurgical treatment outcomes in displaced midshaft clavicle fractures.
PubMed, MEDLINE, EMBASE, Web of Science, Cochrane Library, and ClinicalTrials.gov were searched in September 2017.
Inclusion criteria were randomized controlled trials reporting nonunion, shoulder functional outcomes, and subsequent surgery rates or pain scores. We excluded studies with patients younger than 16 years, maximum follow-up less than 9 months, and inaccessible full text.
Extracted data included the first author, publication year, number of patients, number of nonunions, Constant scores, disabilities of the arm, shoulder, and hand (DASH) scores, number of subsequent surgeries, and pain measured using the visual analog scale.
The risk ratio of nonunion was 0.15 [95% confidence interval (CI), 0.08-0.31] in ORIF compared with that of nonsurgical treatment. Constant and DASH scores were significantly better in ORIF up to 6 months. The mean difference (MD) in DASH scores at 12 months was statistically insignificant in both treatments (MD, -4.19; 95% CI, -9.34 to 0.96). Constant scores remained significant in ORIF (MD, 4.39; 95% CI, 1.03-7.75). Subsequent surgeries and pain scores were similar in both treatments.
Significant reduction in nonunions and favorable early functional outcomes are associated with ORIF. Nevertheless, late functional outcomes, subsequent surgeries, and pain scores are similar to those of nonsurgical treatment. Although patients treated with ORIF mainly had subsequent elective plate removals, nonsurgically treated patients had more surgical fixations for nonunions. As a result, there remains inconsistent evidence regarding the best treatment for displaced midshaft clavicle fractures.
Therapeutic Level I. See Instructions for Authors for a complete description of levels of evidence.
比较切开复位内固定（ORIF）与非手术治疗移位型锁骨中段骨折的疗效。
2017 年 9 月检索了 PubMed、MEDLINE、EMBASE、Web of Science、Cochrane 图书馆和 ClinicalTrials.gov。
纳入标准为报告骨不连、肩部功能结果和后续手术率或疼痛评分的随机对照试验。我们排除了患者年龄<16 岁、随访时间<9 个月和无法获取全文的研究。
提取的数据包括第一作者、发表年份、患者人数、骨不连人数、Constant 评分、上肢功能障碍评分（DASH）、后续手术次数和视觉模拟评分（VAS）测量的疼痛。
ORIF 组的骨不连风险比为 0.15（95%置信区间，0.08-0.31），低于非手术治疗组。ORIF 组在 6 个月内 Constant 和 DASH 评分显著更好。两种治疗方法在 12 个月时 DASH 评分的平均差值（MD）无统计学意义（MD，-4.19；95%置信区间，-9.34 至 0.96）。ORIF 组 Constant 评分仍有显著差异（MD，4.39；95%置信区间，1.03-7.75）。两种治疗方法的后续手术和疼痛评分相似。
ORIF 可显著降低骨不连发生率并获得早期良好的功能结果。然而，晚期功能结果、后续手术和疼痛评分与非手术治疗相似。尽管接受 ORIF 治疗的患者主要进行了后续的选择性钢板取出术，但非手术治疗的患者因骨不连进行了更多的手术固定。因此，对于移位型锁骨中段骨折的最佳治疗方法仍存在不一致的证据。
治疗学 1 级。详见作者说明了解完整的证据等级描述。
