Department of Orthopaedic and Trauma Surgery, Lucerne Cantonal Hospital, Spitalstrasse, 6000, Lucerne, Switzerland.
Department of Health Science and Medicine, University of Lucerne, Frohburgstrasse 3, 6002, Lucerne, Switzerland.
Eur J Trauma Emerg Surg. 2022 Aug;48(4):3063-3071. doi: 10.1007/s00068-021-01845-3. Epub 2022 Mar 2.
Low profile dual plate fixation using two mini fragment plates (< 2.7 mm thickness) is a relatively new technique and alternative to single plating for treating midshaft clavicle fractures. To date, no meta-analysis has been performed comparing these two techniques. Therefore, a systematic review and meta-analysis of observational studies and randomized clinical trials was performed comparing single plating to low profile dual plating for midshaft clavicle fractures.
PubMed/Medline/Embase/CENTRAL/CINAHL were searched for both randomized clinical trials (RCT) and observational studies comparing both treatments. Effect estimates were pooled across studies using random effects models. The primary outcome is overall complication rate and re-intervention rate. Secondary outcomes include healing, operation duration and functional scores.
Low profile dual plating has favourable outcomes regarding overall complication rate (8.1% vs. 22.5%, OR 0.3, 95% CI 0.2-0.7, I = 16%, p = 0.007) and re-intervention rate (6.1% vs. 16.1%, OR 0.3, 95% CI 0.1-0.9, I = 25%, p = 0.02). The largest contributing factor behind these differences was the high incidence of implant related complaints in the single plating group (4.7% vs. 11.6%, OR 0.4, 95% CI 0.2-0.9, I = 0%, p = 0.02). The use of low profile dual plating does not have a detrimental effect on healing with union being attained in 99% compared to 97.4% in the single plating group (OR 1.8, 95% CI 0.3-10.7, I = 0%, p = 0.5). Data on operating time and functional results is limited.
This meta-analysis shows that dual plating low profile plates for midshaft clavicle fractures is a safe procedure attaining the same union rates seen in patients treated with single plating. In addition, it seems to have a lower overall complication and re-intervention rate, mostly driven by the lower incidence of implant related complaints. Low profile dual plating, however, is a fairly new technique and should be further explored in respect to more differentiated endpoints to test whether these first findings are valid.
III.
使用两块<2.7mm 厚度的微型接骨板的低切迹双钢板固定是一种相对较新的技术，可作为治疗锁骨中段骨折的单钢板固定的替代方法。迄今为止，尚未对这两种技术进行荟萃分析。因此，我们进行了一项系统的文献回顾和荟萃分析，比较了单钢板固定和低切迹双钢板固定治疗锁骨中段骨折的疗效。
在 PubMed/Medline/Embase/CENTRAL/CINAHL 中检索了比较两种治疗方法的随机临床试验（RCT）和观察性研究。使用随机效应模型对研究间的效应估计值进行合并。主要结局指标为总并发症发生率和再干预率。次要结局指标包括愈合、手术时间和功能评分。
低切迹双钢板固定的总并发症发生率（8.1%比 22.5%，OR 0.3，95%CI 0.2-0.7，I²=16%，p=0.007）和再干预率（6.1%比 16.1%，OR 0.3，95%CI 0.1-0.9，I²=25%，p=0.02）均有较好的结果。这些差异的最大影响因素是单钢板固定组中植入物相关并发症的发生率较高（4.7%比 11.6%，OR 0.4，95%CI 0.2-0.9，I²=0%，p=0.02）。使用低切迹双钢板固定并不会对愈合产生不利影响，两组的愈合率均为 99%，与单钢板固定组的 97.4%（OR 1.8，95%CI 0.3-10.7，I²=0%，p=0.5）相似。关于手术时间和功能结果的数据有限。
本荟萃分析表明，对于锁骨中段骨折，使用低切迹双钢板固定是一种安全的方法，可获得与单钢板固定相同的愈合率。此外，它似乎具有较低的总体并发症和再干预率，这主要归因于植入物相关并发症的发生率较低。然而，低切迹双钢板固定是一种相对较新的技术，应该进一步探索更具差异化的终点，以验证这些初步发现是否有效。
III。
