Uittenbogaard Sophie J, van Es Laurian J M, den Haan Chantal, van Deurzen Derek F P, van den Bekerom Michel P J
Department of Orthopaedic Surgery, Shoulder Elbow Expertise Centre, OLVG Hospital, Amsterdam, the Netherlands.
Department of Orthopaedic Surgery, IJsselland Ziekenhuis, Capelle aan den IJssel, the Netherlands.
Am J Sports Med. 2023 Feb;51(2):534-544. doi: 10.1177/03635465211053336. Epub 2021 Nov 15.
As nonoperative treatment of Neer type II distal clavicle fractures is associated with nonunion rates up to 33%, operative treatment is frequently advocated. However, evidence is lacking regarding which operative treatment to perform and whether this is superior to nonoperative treatment in terms of functional outcome and complication rate.
(1) To evaluate which surgical technique in the treatment of Neer type II distal clavicle fractures is optimal with regard to patient-reported outcomes and union and complication rates. (2) To review nonoperatively treated patients.
Systematic review; Level of evidence, 4.
A systematic review of the literature and meta-analysis were performed on January 27, 2021, in PubMed, Embase, CENTRAL, CINAHL/EBSCO, Web of Science/Clarivate Analytics, and SPORTDiscus/EBSCO. The search included all studies regarding nonoperative and operative treatment of Neer type II distal clavicle fractures with a minimum of 20 patients and follow-up of 12 months. The primary and secondary outcomes were patient-reported outcome measures at 12 months and union, complication, and revision rates.
A total of 59 articles were included involving 2284 patients. Coracoclavicular fixation, hook plate, transacromial pins, alternative plate, tension band wire/K-wire, a combination of surgical techniques, and a nonoperative group were described. Hook plates showed lower Constant-Murley scores as compared with coracoclavicular fixation (standard mean difference, -0.77; 95% CI, -1.26 to -0.28; = .002). However, no significant difference was seen when the hook plate was compared with the locking plate and tension band wire/K-wire groups, and no significant difference in union rate was seen among all operative treatment groups. Operatively treated patients had significantly higher union rates than patients treated nonoperatively (standard mean difference: 0.05; 95% CI, 0.01 to 0.37; = .004).
Patients treated with hook plates showed significantly lower Constant-Murley scores and higher complication and revision rates as compared with those treated with coracoclavicular fixation, without differences in union rate. Higher Constant-Murley scores were seen in those patients with supplemental coracoclavicular fixation when using locking. Nonoperatively treated patients showed good functional outcome despite the 31% nonunion rate, although future studies are necessary to substantiate this conclusion. When using a locking plate, additional craniocaudal fixation showed significant better functional outcome.
由于Neer II型锁骨远端骨折的非手术治疗不愈合率高达33%，因此经常提倡手术治疗。然而，关于采用哪种手术治疗以及在功能结果和并发症发生率方面手术治疗是否优于非手术治疗，目前缺乏证据。
（1）评估在治疗Neer II型锁骨远端骨折时，哪种手术技术在患者报告的结果、愈合及并发症发生率方面是最佳的。（2）对非手术治疗的患者进行回顾。
系统评价；证据等级，4级。
于2021年1月27日在PubMed、Embase、CENTRAL、CINAHL/EBSCO、Web of Science/科睿唯安分析和SPORTDiscus/EBSCO数据库中进行文献系统评价和荟萃分析。检索包括所有关于Neer II型锁骨远端骨折非手术和手术治疗的研究，研究对象至少20例，随访时间为12个月。主要和次要结局指标为12个月时患者报告的结局指标、愈合率、并发症发生率及翻修率。
共纳入59篇文章，涉及2284例患者。描述了喙锁固定、钩钢板、经肩峰克氏针、替代钢板、张力带钢丝/克氏针以及手术技术组合和非手术治疗组。与喙锁固定相比，钩钢板的Constant-Murley评分较低（标准均差，-0.77；95%可信区间，-1.26至-0.28；P = 0.002）。然而，将钩钢板与锁定钢板及张力带钢丝/克氏针组进行比较时，未发现显著差异，且所有手术治疗组的愈合率也无显著差异。手术治疗的患者愈合率显著高于非手术治疗的患者（标准均差：0.05；95%可信区间，0.01至0.37；P = 0.004）。
与喙锁固定治疗的患者相比，钩钢板治疗的患者Constant-Murley评分显著较低，并发症和翻修率较高，但愈合率无差异。使用锁定钢板时，补充喙锁固定的患者Constant-Murley评分较高。尽管非手术治疗的患者不愈合率为31%，但其功能结局良好，不过未来仍需开展研究以证实这一结论。使用锁定钢板时，额外的矢状面固定显示功能结局显著更好。
