摘要
目的通过Meta分析比较解剖锁定板内固定联合与不联合带线锚钉重建喙锁韧带(reconstruction of coracoclavicular ligament with thread anchor,RCLTA)治疗不稳定性锁骨远端骨折疗效的差异。方法计算机检索PubMed、Embase、Cochrane图书馆、中国知网、万方和维普数据库,并辅以手工检索,收集自建库至2022年6月所有比较解剖锁定板内固定联合与不联合RCLTA治疗不稳定性锁骨远端骨折的随机对照研究或病例对照研究。严格评价纳入研究的文献质量,并提取相关数据资料(切口长度、手术时间、术中出血量、住院时间、骨折愈合时间、术后并发症、末次随访喙锁间距、末次随访Costant-Murley肩关节功能评分),运用RevMan5.4软件进行Meta分析。结果共纳入8篇回顾性队列研究,患者共279例。其中重建组行解剖锁定板内固定联合喙锁韧带(coracoclavicular,CC)重建138例,非重建组行单纯解剖锁定板内固定141例。Meta分析结果显示:非重建组手术时长短于重建组[MD=8.88,95%CI(3.76,13.99),P<0.05],末次随访喙锁间距大于重建组[MD=-0.43,95%CI(-0.66,-0.20),P<0.05],末次随访Costant-Murley肩关节功能评分低于重建组[MD=4.67,95%CI(1.52,7.82),P<0.05],骨折愈合时间长于重建组[MD=-0.98,95%CI(-1.94,-0.02),P=0.04]。而非重建组与重建组在切口长度[MD=0.34,95%CI(-0.17,0.86),P=0.19]、住院时间[MD=-0.69,95%CI(-1.51,0.12),P=0.10]、术中出血量[MD=11.66,95%CI(-2.31,25.63),P=0.10]及术后并发症[OR=1.07,95%CI(0.42,2.71),P=0.89]方面的比较,差异均无统计学意义。结论与单纯解剖锁定板内固定相比,解剖锁定板联合RCLTA治疗不稳定性锁骨远端骨折末次随访喙锁间距小、Costant-Murley肩关节功能评分高、骨折愈合时间短、联合RCLTA疗效确切,是一种有效的治疗选择。该结论有待于进一步前瞻性、大样本随机对照研究的验证。
Background The clavicle is the frame bone that connects the upper limbs and the trunk,and clavicle fractures account for about 2.6%of all fractures in the whole body.Distal clavicle fractures occur in the lateral 1/3 of the clavicle,accounting for about 21%-28%of all clavicle fractures.The modified Neer classification divides distal clavicle fractures into types I to V according to the relationship between the fracture line,the coracoclavicular ligament(CC),and the acromioclavicular joint.Neer I,III,and IV fractures can achieve an excellent curative effect through non-surgical treatment of the affected limb suspension brace;Neer II and V types are unstable fractures with large displacement,and non-operative treatment of nonunion High incidence,often choose surgery.Relevant studies have shown that 68%of the fixation methods use anatomical locking plates,which may be related to its advantages of fitting the shape of the distal clavicle,stably fixing minor fractures,and allowing early movement of the affected arm.Complications such as shoulder joint pain are more common,and the current use is gradually decreasing.Unstable distal clavicle fractures are often accompanied by a coracoclavicular ligament injury,which causes stress concentration in the distal clavicle.Whether an anatomical locking plate should be combined with CC reconstruction to relieve distal stress is still controversial.Some scholars believe that when the locking plate remains stable,the CC will heal in a tension-free state,and the strength is close to that of normal ligaments.No other CC reconstruction is required,and an excellent curative effect can be obtained by simple anatomical locking plate fixation.Other scholars believe that the injury of the coracoclavicular ligament leads to severe displacement of the fracture end and increases the chance of nonunion after surgery.Therefore,anatomical locking plate fixation combined with CC reconstruction is advocated for treatment.Objective Meta-analysis was used to compare the efficacy of anatomical lock
作者
刘泽民
张经
王栋
李岩
常诗语
张永红
Zemin Liu;Jing Zhang;Dong Wang;Yan Li;Shiyu Chang;Yonghong Zhang(Department of Orthopedics,The Second Hospital of Shanxi Medical University,Taiyuan 030001,China;Guizhou Medical University,Guiyang 550025,China)
出处
《中华肩肘外科电子杂志》
2023年第1期53-62,共10页
Chinese Journal of Shoulder and Elbow(Electronic Edition)
基金
国家自然科学基金面上项目(82172439)。
关键词
锁骨骨折
骨折内固定术
喙锁韧带重建
META分析
Clavicular fracture
Fracture fixation
Internal
Coracoclavicular ligament reconstruction
Meta-analysis
