Implant fixation versus conservative treatment for clavicle fractures: a meta-analysis

doi:10.3969/j.issn.2095-4344.2014.22.021

Abstract

Abstract:

BACKGROUND: It is still disputed at present about the treatment selection for clavicle fractures, operative or conservative treatment.

OBJECTIVE: To evaluate the effects of operative and non-operative (conservative) treatment for clavicle fractures with the method of meta-analysis.

METHODS: We retrieved PUBMED, EMBASE, OVID, Cochrane library, Science Direct, Springer Link, China National Knowledge Infrastructure and Wanfang Database for articles on treatment of clavicle fractures published from January 2000 to December 2013. According to specific inclusion and exclusion criteria, relevant literatures about treatments of clavicle fractures were searched for data source extraction, which were used for meta-analysis using Review Manager 5.0 software.

RESULTS AND CONCLUSION: Six randomized controlled trials were included, including 570 patients. Meta-analysis results demonstrated that for clavicle fractures, implant fixation could decrease nonunion rate [RR=0.16, 95%CI(0.07, 0.38), P < 0.000 1], malunion rate [RR=0.15, 95%CI(0.07, 0.34), P < 0.000 01], delayed union rate [RR=0.20, 95%CI(0.06, 0.70), P=0.01] and the incidence of residual pain at 1 year after treatment [RR=0.24, 95%CI(0.12, 0.51), P=0.000 2], could elevate Constant Score [MD=3.68, 95%CI(1.61, 5.76), P=0.000 5]. However, it was not concluded that fixation could reduce the incidence of neurological complications [RR=0.63, 95%CI(0.06, 0.70), P=0.22]. It is suggested that implant fixation for clavicle fractures obtained good clinical effects. However, due to the disadvantages of the included literatures, we still needed high-quality multicenter randomized controlled trials to further verify conclusions, and should pay more attention on patients’ individual conditions when the therapeutic methods for clavicle fractures were selected in the clinic.

中国组织工程研究杂志出版内容重点：人工关节；骨植入物；脊柱；骨折；内固定；数字化骨科；组织工程

全文链接：

Key words: prostheses and implants, clavicle, fractures, bone, internal fixators, meta-analysis

CLC Number:

R318

Yang Fan, Wang Dong, Sun Hai-yu, Xu Kun, Ning Si-min, Li Yang, Zhao Chen. Implant fixation versus conservative treatment for clavicle fractures: a meta-analysis[J]. Chinese Journal of Tissue Engineering Research, 2014, 18(22): 3567-3573.

Figures/Tables 3

2.2 Meta分析结果 2.2.1 骨不愈合率共6篇随机对照试验报道了骨不愈合率[19-24]。Meta分析结果表明，研究效应量同质(I2=0%，P=0.48)，采用M-H固定效应模型。两组相比差异有显著性意义[RR=0.16，95%CI(0.07，0.38)，P < 0.000 1]，认为与保守治疗相比，内固定治疗可以降低骨不连率(图1)。 2.2.2 骨折畸形愈合率共4篇随机对照试验报道了骨折畸形愈合率[19-20，22-23]。Meta分析结果表明，研究效应量同质(I2=0%，P=0.76)，采用固定效应模型。两组相比差异有显著性意义[RR=0.15，95%CI(0.07，0.34)，P < 0.000 01]，认为与保守治疗相比，内固定治疗可以降低畸形愈合率 (图2)。 2.2.3 骨折延迟愈合率共4篇随机对照试验报道了骨折延迟愈合率[19-21，24]。Meta分析结果表明，研究效应量同质(I2=41%，P=0.18)，采用固定效应模型。两组相比差异有显著性意义[RR=0.20，95%CI(0.06，0.70)，P=0.01]，认为与保守治疗相比，内固定治疗可以降低骨折延迟愈合率(图3)。 2.2.4 神经并发症发生率共6篇随机对照试验报道了神经症状发生率[19-24]，其中5篇纳入研究。Meta分析结果表明，研究效应量同质性明显(I2=0%，P=0.51)，采用固定效应模型。两组相比差异无显著性意义[RR=0.63，95%CI (0.06，0.70)，P=0.22]，与保守治疗相比，尚不能认为内固定治疗可以降低神经症状发生率(图4)。 2.2.5 治疗后1年残余疼痛发生率共4篇随机对照试验报道了治疗后1年残余疼痛发生率[19，22-24]。Meta分析结果表明，研究效应量同质性明显(I2=19%，P=0.30)，采用固定效应模型。两组相比差异有显著性意义[RR=0.24，95%CI(0.12，0.51)，P=0.000 2]，认为与保守治疗相比，内固定治疗可以降低治疗后1年残余疼痛发生率(图5)。 2.2.6 CS评分共2篇随机对照试验中关于CS评分的数据可以使用[19-20]。Meta分析结果表明，研究效应量同质性明显(I2=34%，P=0.22)，采用固定效应模型。两组相比差异有显著性意义[MD=3.68，95%CI(1.61，5.76)，P=0.000 5]，认为与保守治疗相比，内固定治疗可以提高CS评分(图6)。"

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