中国组织工程研究

中国组织工程研究 ›› 2021, Vol. 25 ›› Issue (18): 2923-2929.doi: 10.3969/j.issn.2095-4344.3838

• 骨与关节循证医学 evidence-based medicine of the bone and joint • 上一篇    下一篇

桥接组合式内固定系统与锁定钢板治疗锁骨中段骨折的Meta分析

吴  桐1，熊  鹰1，李焕龙1，陈  勇2，刘璐赟2，张  珑1，秦  晶1，Md Ariful Haque1   

  1. 1昆明医科大学附属延安医院骨科，云南省昆明市   650051；2云南中医药大学，云南省昆明市   650051
  • 收稿日期:2020-07-21 修回日期:2020-07-22 接受日期:2020-09-05 出版日期:2021-06-28 发布日期:2021-01-12
  • 通讯作者: 熊鹰，昆明医科大学附属延安医院骨科，云南省昆明市 650051
  • 作者简介:吴桐，男，1990年生，云南省昆明市人，汉族，硕士。
  • 基金资助:
    昆明市卫生健康委员会卫生科研课题项目(2020-04-07-121)，项目负责人：熊鹰

Meta-analysis on middle clavicle fracture treated with Ortho-Bridge System and locking plate

Wu Tong1, Xiong Ying1, Li Huanlong1, Chen Yong2, Liu Luyun2, Zhang Long1, Qin Jing1, Md Ariful Haque1   

  1. 1Department of Orthopedics, Yan’an Hospital Affiliated to Kunming Medical University, Kunming 650051, Yunnan Province, China; 2Yunnan University of Traditional Chinese Medicine, Kunming 650051, Yunnan Province, China
  • Received:2020-07-21 Revised:2020-07-22 Accepted:2020-09-05 Online:2021-06-28 Published:2021-01-12
  • Contact: Xiong Ying, Department of Orthopedics, Yan’an Hospital Affiliated to Kunming Medical University, Kunming 650051, Yunnan Province, China
  • About author:Wu Tong, Master, Department of Orthopedics, Yan’an Hospital Affiliated to Kunming Medical University, Kunming 650051, Yunnan Province, China
  • Supported by:
    the Health Research Project of Kunming Health Committee, No. 2020-04-07-121 (to XY) 

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摘要：

文题释义：
锁骨中断骨折：锁骨呈“S状”，中段交界处为最薄弱部位，也是骨折最容易发生的部位，中段骨折约占所有锁骨骨折的80%。
桥接棒：桥接棒由于其棒状结构，塑性较钢板简单，塑性后强度下降程度较钢板低。利用桥接系统治疗锁骨中段骨折，大部分学者采用的是3或4号单棒固定，也有学者根据不同类型骨折采取3号双棒固定。

目的：目前临床上治疗锁骨中段骨折最常用的是锁定钢板，桥接组合式内固定系统是一种新型内固定器械，其用于治疗锁骨中段骨折时间并不长，但是国内许多学者已经发表了很多篇临床研究来比较两者的疗效，但是尚无统一意见。文章对桥接组合式内固定系统和锁定钢板治疗锁骨中段骨折的临床疗效进行Meta分析。
方法：应用计算机检索PubMed、Medline、The Cochrane Library、迈特思创FMRS外文医学信息平台、OVID医学期刊全文数据库、维普、中国知网和万方数字化期刊平台，收集2010年1月至2020年4月发表的对比桥接组合式内固定系统和锁定钢板治疗锁骨中段骨折的临床对照试验。根据纳入标准和排除标准筛选文献，采用Jadad量表和MINORS评分表进行文献质量评估，对纳入的研究进行质量评价以及数据提取，选择手术时间、术中出血量、骨折愈合时间、并发症及术后1年肩关节功能评分作为Meta分析的评价指标，利用Cochrane协作网提供的RevMan 5.2软件对纳入研究结果进行Meta分析。
结果：①文章纳入了中文及外文文献共9篇，其中随机对照试验3篇，非随机对照试验6篇，共计613例锁骨中段骨折的患者，其中桥接组280例，钢板组333例；②通过Meta分析可得：两种方法在术后肩关节功能(MD=3.23，95%CI：0.13-6.33，P=0.04)方面差异无显著性意义，但桥接组在手术时间(MD=-4.62，95%CI：-9.08至-0.16，P=0.04)、术中出血量(MD=-15.29，95%CI：-15.81至-14.47，P < 0.000 01)、骨折愈合时间(MD=-2.88，95%CI：-3.10至-2.65，P < 0.000 01)和总体并发症(OR=0.21，95%CI：0.09-0.48，P=0.000 2)方面均优于钢板组。
结论：桥接组合式内固定系统与锁定钢板两种内固定技术治疗锁骨中段骨折，均能达到预期的治疗效果，两种修复方法在术后肩关节功能方面无显著差异，桥接组合式内固定系统在手术时间、术中出血量、骨折愈合时间及总体并发症方面较锁定钢板有一定优势。但限于该研究方法学质量的影响，文章结果还需谨慎对待，未来尚需要更多大样本、多中心随机对照试验进一步证实。

关键词: 骨, 锁骨, 骨折, 肩关节, 内固定, 钢板, 中段骨折, Meta分析

Abstract: OBJECTIVE: Locking plate is the most commonly used method for the treatment of middle clavicle fracture at present. Ortho-Bridge System is a new type of internal fixation device, which has not been used for a long time. However, many domestic scholars have published many clinical studies to compare the efficacy of the two, but there is no unified opinion. This study compared the efficacy of Ortho-Bridge System and locking plate in the treatment of middle clavicle fracture by meta-analysis. 
METHODS: A computer-based online search was conducted in PubMed, Medline, The Cochrane Library, MSTC FMRS foreign medical information platform, Ovid Medical Journal Full-text Database, VIP, CNKI, Wanfang digital journal and other platforms to collect the randomized controlled trials published from January 2010 to April 2020 on the treatment of middle clavicular fracture with the combination of Ortho-Bridge System and locking plate. According to the inclusion and exclusion criteria, Jadad scale and MINORS scale were used to evaluate the quality of the included articles. After quality evaluation and data extraction, the operation time, intraoperative blood loss, fracture healing time, complications and 1-year postoperative shoulder joint function score were selected as the evaluation indicators for meta-analysis. The results of the included studies were meta analyzed by RevMan 5.2 software provided by Cochrane Collaboration Network.
RESULTS: (1) A total of nine Chinese and foreign articles were included in this study, including three randomized controlled trials and six non randomized controlled trials. A total of 613 patients with middle clavicle fractures were included, including 280 cases in the Ortho-Bridge System group and 333 cases in the locking plate group. (2) Meta-analysis results showed that there was no significant difference in postoperative shoulder function (MD=3.23, 95%CI:0.13-6.33, P=0.04). However, the Ortho-Bridge System group was better than the locking plate group in operation time (MD=-4.62, 95%CI:-9.08 to -0.16, P=0.04), intraoperative blood loss (MD=-15.29, 95%CI:-15.81 to -14.47, P < 0.000 01), fracture healing time (MD=-2.88, 95%CI:-3.10 to -2.65, P < 0.000 01), and overall complications (OR=0.21, 95%CI:0.09-0.48, P=0.000 2).
CONCLUSION: Ortho-Bridge System and locking plate can achieve the expected results in the treatment of mid clavicle fracture. There was no significant difference in shoulder function between the two methods. In terms of operation time, intraoperative blood loss, fracture healing time and overall complications, Ortho-Bridge System has certain advantages over locking plate. However, due to the influence of methodological quality of this study, the results need to be treated with caution, and more large sample and multi center randomized controlled trials are needed to confirm.

Key words: bone, clavicle, fracture, shoulder joint, internal fixation, plate, middle fracture, meta-analysis

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