Department of Orthopaedic Surgery, The Royal Melbourne Hospital, Parkville, Victoria, Australia.
Department of Surgery (RMH), The University of Melbourne, Royal Melbourne Hospital, Melbourne, Victoria, Australia.
J Orthop Trauma. 2019 Aug;33(8):417-422. doi: 10.1097/BOT.0000000000001481.
To compare the outcome of hook plate fixation with other techniques in surgical fixation of acute unstable distal clavicle fractures.
In July 2018, a systematic search of electronic databases (PubMed, Medline, Embase, and Cochrane databases for systematic reviews) was performed according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guideline. Articles were limited to English language.
Studies were included if they compared the results of hook plate fixation of acute unstable distal clavicle fracture in adults with other surgical techniques.
Data on the study setting, functional outcome, union, and complication rates were extracted. A quality assessment was performed using the Newcastle-Ottawa Scale.
Eleven studies were found that met the inclusion criteria. Six hundred thirty-four patients were pooled using a random effects model. There were 397 male and 237 female patients. Primary outcome measure was functional result, and the secondary outcome measures were union and complication rates. There was no significant difference between the functional outcome and union rate between hook plate fixation, coracoclavicular (CC) stabilization, and locking plate fixation. Hook plate fixation resulted in a higher Constant-Murley score compared with tension band wiring (TBW) [odds ratio (OR), 3.52; 95% confidence interval (CI), 0.79-6.26]. It was also associated with a higher complication rate compared with CC stabilization (OR, 3.68; 95% CI, 1.19-11.33) and the locking plate (OR, 5.19; 95% CI, 1.58-17.06). Compared with TBW, hook plate fixation was associated with a lower complication rate (OR, 0.28; 95% CI, 0.10-0.77).
Hook plate fixation achieves a similar functional outcome and union rate compared with CC stabilization and locking plate fixation. However, it has a superior functional result compared with TBW. The complication rate is higher compared with CC stabilization and locking plate fixation and is lower compared with TBW.
Therapeutic Level III. See Instructions for Authors for a complete description of levels of evidence.
比较钩钢板固定与其他技术在急性不稳定型锁骨远端骨折手术固定中的疗效。
2018 年 7 月，根据系统评价和荟萃分析的首选报告项目，对电子数据库（PubMed、Medline、Embase 和 Cochrane 数据库）进行了系统检索。文章仅限于英文。
如果研究比较了成人急性不稳定型锁骨远端骨折钩钢板固定与其他手术技术的结果，则纳入研究。
提取研究背景、功能结果、愈合率和并发症发生率的数据。使用纽卡斯尔-渥太华量表进行质量评估。
共发现符合纳入标准的 11 项研究。使用随机效应模型对 634 例患者进行了汇总。其中男性 397 例，女性 237 例。主要结局指标为功能结果，次要结局指标为愈合率和并发症发生率。钩钢板固定、喙锁固定和锁定钢板固定在功能结果和愈合率方面无显著差异。与张力带固定（TBW）相比，钩钢板固定的 Constant-Murley 评分更高[比值比（OR），3.52；95%置信区间（CI），0.79-6.26]。与 CC 固定（OR，3.68；95% CI，1.19-11.33）和锁定钢板（OR，5.19；95% CI，1.58-17.06）相比，钩钢板固定的并发症发生率更高。与 TBW 相比，钩钢板固定的并发症发生率较低（OR，0.28；95% CI，0.10-0.77）。
钩钢板固定在功能结果和愈合率方面与 CC 固定和锁定钢板固定相似。然而，与 TBW 相比，它具有更好的功能结果。与 CC 固定和锁定钢板固定相比，并发症发生率较高，与 TBW 相比，并发症发生率较低。
治疗性 III 级。请参阅作者说明，以获取完整的证据水平描述。
