Li Lang, Yang Xiaodong, Xing Fei, Jiang Jun, Tang Xueyang
Department of Pediatric Surgery.
Department of Orthopedics, West China Hospital, Sichuan University, Chengdu, Sichuan, China.
Medicine (Baltimore). 2020 Sep 25;99(39):e22284. doi: 10.1097/MD.0000000000022284.
Plate fixation and intramedullary nail/Knowles pin fixation methods are commonly used to treat displaced midshaft clavicle fractures. However, the differences between these 2 methods are unclear.
This meta-analysis aimed to compare plate fixation and intramedullary nail/Knowles pin fixation for displaced midshaft clavicle fractures.
We searched PubMed, EBM reviews, and Ovid Medline online for studies related to comparison of plate fixation versus intramedullary nail/Knowles pin fixation for displaced midshaft clavicle fracture from inception to June 30, 2019. Relevant literature search, data extraction, and quality assessment will be performed by 2 researchers independently. The methodological quality of all included studies was appraised using the Cochrane system for randomized trials. The RevMan 5.2 software was used for heterogeneity assessment, generating funnel-plots, data synthesis, sensitivity analysis, and determining publication bias. The fixed-effects or random-effects model was used to calculate mean difference (MD)/relative risks (RRs) and 95% confidence intervals (CIs).
This meta-analysis included 839 patients from 12 randomized controlled trials. We found that compared to plate fixation, intramedullary nail/Knowles pin fixation yielded a higher shoulder constant score [MD = -2.43, 95% CI (-3.46 to -1.41), P < .00001] and lower disabilities of the arm, shoulder and hand (DASH) score [MD = 2.98, 95% CI (0.16-5.81), P = .04], and lower infection rates [RR = 2.05, 95% CI (1.36-3.09), P = .003], operation time [MD = 20.20, 95% CI (10.80-29.60), P < .0001], incision size [MD = 6.09, 95% CI (4.54-7.65), P < .00001], and hospital stay [MD = 1.10, 95% CI (0.56-1.64), P < .00001] but with a higher removal rate [RR = 0.52, 95% CI (0.41-0.65), P < .00001] compared to plate fixation. There were no significant differences in nonunion, reintervention, or revision and refracture between these two methods. The limitation is that many studies did not demonstrate the random generated details, and only English articles were enrolled in this meta-analysis.
Intramedullary nail/Knowles pin fixation might be an optimum choice for treating displaced midshaft clavicle fractures, with similar performance in terms of the nonunion, reintervention, or revision and refracture, and better shoulder constant and DASH scores, infection rates, and operative parameters.
钢板固定和髓内钉/诺尔斯针固定方法常用于治疗移位的锁骨中段骨折。然而，这两种方法之间的差异尚不清楚。
本荟萃分析旨在比较钢板固定与髓内钉/诺尔斯针固定治疗移位的锁骨中段骨折的效果。
我们在PubMed、循证医学评论和Ovid Medline在线数据库中检索了从数据库建立至2019年6月30日期间，有关钢板固定与髓内钉/诺尔斯针固定治疗移位的锁骨中段骨折比较的研究。由两名研究人员独立进行相关文献检索、数据提取和质量评估。使用Cochrane随机试验系统对所有纳入研究的方法学质量进行评估。采用RevMan 5.2软件进行异质性评估、生成漏斗图、数据合成、敏感性分析以及确定发表偏倚。使用固定效应或随机效应模型计算平均差（MD）/相对风险（RRs）及95%置信区间（CIs）。
本荟萃分析纳入了12项随机对照试验中的839例患者。我们发现，与钢板固定相比，髓内钉/诺尔斯针固定的肩关节Constant评分更高[MD = -2.43，95%CI（-3.46至-1.41），P＜0.00001]，上肢、肩部和手部功能障碍（DASH）评分更低[MD = 2.98，95%CI（0.16 - 5.81），P = 0.04]，感染率更低[RR = 2.05，95%CI（1.36 - 3.09），P = 0.003]，手术时间更短[MD = 20.20，95%CI（10.80 - 29.60），P＜0.0001]，切口更小[MD = 6.09，95%CI（4.54 - 7.65），P＜0.00001]，住院时间更短[MD = 1.10，95%CI（0.56 - 1.64），P＜0.00001]，但取出率更高[RR = 0.52，95%CI（0.41 - 0.65），P＜0.00001]。这两种方法在骨不连、再次干预、翻修和再骨折方面无显著差异。局限性在于许多研究未展示随机生成的细节，且本荟萃分析仅纳入了英文文章。
髓内钉/诺尔斯针固定可能是治疗移位锁骨中段骨折的最佳选择，在骨不连、再次干预、翻修和再骨折方面表现相似，且肩关节Constant评分和DASH评分、感染率及手术参数更佳。
