中国循证医学杂志

中国循证医学杂志

手术与非手术治疗锁骨中段骨折的 Meta 分析

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目的系统评价手术与非手术治疗锁骨中段骨折的有效性和安全性。方法计算机检索 PubMed、The Cochrane Library、EMbase、MEDLINE(Ovid)、CBM、CNKI 和 WanFang Data 数据库,搜索手术与非手术治疗成人锁骨中段骨折的随机对照试验(RCT)和前瞻性队列研究,检索时限均从建库至 2017 年 6 月 3 日。由 2 位研究者独立筛选文献、提取资料并评价纳入研究的偏倚风险后,采用 RevMan 5.2 软件进行 Meta 分析。结果共纳入 14 个 RCT 和 5 个前瞻性队列研究,合计 1 543 例患者。Meta 结果分析显示:与非手术组相比,手术组能明显提高上肢 Constant 评分[SMD=0.76,95%CI(0.40,1.13),P<0.000 1]并改善肩肘手 DASH 评分[SMD=–0.49,95%CI(–0.91,0.06),P=0.02]。此外,手术组的骨折不愈合率[RR=0.17,95%CI(0.10,0.30),P<0.000 01]及畸形愈合率[RR=0.20,95%CI(0.12,0.33),P<0.000 01]显著降低,患者满意度[RR=1.39,95%CI(1.13,1.71),P=0.002]明显提高。结论当前证据显示,手术治疗锁骨中段骨折能够改善上肢功能,提高患者满意度,降低骨折不良愈合率。但受纳入研究数量和质量的限制,上述结论还需更多高质量研究予以证实。

ObjectiveTo systematically review the safety and efficacy of operative versus non-operative treatment for displaced midshaft clavicle fractures.MethodsDatabases including PubMed, The Cochrane Library, EMbase, MEDLINE(Ovid), CBM, CNKI and WanFang Data were searched to collect randomized controlled trials (RCTs) and cohort studies about operation versus non-operation for displaced midshaft clavicle fractures from inception to June 3rd, 2017. Two reviewers independently screened literature, extracted data and assessed the risk of bias of included studies. Then meta-analysis was performed by RevMan 5.2 software.ResultsA total of 14 RCTs and 5 prospective cohort studies involving 1 543 patients were included. The results of meta-analysis showed that operation was superior to non-operation in the Constant score (SMD=0.76, 95%CI 0.40 to 1.13, P<0.000 1), DASH score (SMD=–0.49, 95%CI –0.91 to 0.06,P=0.02), nonunion rate (RR=0.17, 95%CI 0.10 to 0.30, P<0.000 01), malunion (RR=0.20, 95%CI 0.12 to 0.33,P<0.000 01) and patients’ satisfaction rate (RR=1.39, 95%CI 1.13to 1.71,P=0.002), respectively.ConclusionCurrent evidence shows that operation could improve the function of the upper limbs, reduce nonunion and malunion, and improve the satisfaction of the patients with midshaft clavicle fractures. Due to the limited quality of the included studies, more large-scale, high-quality studies are required to verify the above conclusion.

关键词: 手术; 锁骨中段骨折; 系统评价; Meta 分析; 随机对照试验; 队列研究

Key words: Operation; Midshaft clavicle fracture; Systematic review; Meta-analysis; Randomized controlled trial; Cohort study

引用本文: 李浪, 陈龙, 邢飞, 项舟. 手术与非手术治疗锁骨中段骨折的 Meta 分析. 中国循证医学杂志, 2018, 18(5): 489-497. doi: 10.7507/1672-2531.201708042 复制

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