Different interventions and implants for the functional recovery and complications of displaced midshaft clavicular fractures: a network meta-analysis

doi:10.3969/j.issn.2095-4344.1476

Abstract

Abstract:

BACKGROUND: There are many treatments for displaced midshaft clavicular fractures. However, there are few studies on different treatments for the evaluation of displaced midshaft clavicular fractures. Therefore, systematic analysis is carried out for different interventions.

OBJECTIVE: To systematically review the efficacy and safety of different interventions for the treatment of displaced midshaft clavicular fractures.

METHODS: PubMed, EMbase and Cochrane Central databases were searched by computer to retrieve randomized controlled trials of different interventions for the treatment of displaced midshaft clavicular fractures. The search time was from the inception to December 2018. Two researchers conducted literature screening and data extraction, and evaluated the risk of bias in the included studies. Data analysis was performed using R 3.5.1 and the risk assessment map was generated by RevMan 5.3 software.

RESULTS AND CONCLUSION: A total of 23 randomized controlled trials involving 2 234 patients were included. (1) In terms of Constant score: The network meta-analysis showed that the plate (locking plate, non-locking plate) was superior to the sling, and the difference was statistically significant. Probability ranking results showed that intramedullary pins, non-locking plates, and elastic intramedullary nails were superior to others. (2) In terms of DASH scores: The results of the network meta-analysis showed that the comparison of the two interventions in the treatment of displaced midshaft clavicle fractures showed no statistical difference. (3) In terms of nonunion rate: The results of network meta-analysis showed that elastic intramedullary nails, non-locking plates, and locking plates were superior to the nonoperative treatments (sling, figure-of-eight bandage), and the differences were statistically significant. Probability sorting results showed that elastic intramedullary nails, non-locking plates, and locking plates were superior to others. (4) In terms of infection rate: The results of network analysis showed that intramedullary nails (elastic intramedullary nails, intramedullary pins) were superior to plates (locking plates, non-locking plates), and the differences were statistically significant. Probability sorting results showed that intramedullary pins and elastic intramedullary nails were superior to others. (5) In terms of healing time: The results of network analysis showed that elastic intramedullary nails were superior to slings, and non-locking plates were superior to slings, and the difference was statistically significant. Probability ranking results showed that intramedullary pins, non-locking plates, and elastic intramedullary nails were superior to others. (6) Based on the results of network meta-analysis, probability ordering and node resolution analysis of functional scores, nonunion rate, infection rate, and healing time, this study considers that elastic intramedullary nail is the first choice for the treatment of displaced midshaft clavicular fractures.

Key words: displaced midshaft clavicular fractures, network meta-analysis, elastic intramedullary nail, functional recovery, complications, Bayes, randomized controlled trial

CLC Number:

R459.9|R683|R318

Chen Zhe, Shi Qingyang, Gao Zhuo, Peng Yingying, Wang Yongqing. Different interventions and implants for the functional recovery and complications of displaced midshaft clavicular fractures: a network meta-analysis[J]. Chinese Journal of Tissue Engineering Research, 2019, 23(32): 5240-5248.

Figures/Tables 7

2.5.3 不愈合率不愈合率的网状比较结果：各干预措施与吊带相比的结果显示，8字绷带的不愈合率结果无统计学差异[RR=1.4，95%Cr(0.27，12)]；锁定钢板的不愈合率结果有统计学差异[RR=0.14，95%Cr(0.058，0.29)]；非锁定钢板的不愈合率结果有统计学差异[RR=0.14，95%Cr(0.073，0.26)]；弹性髓内钉的不愈合率结果有统计学差异[RR=0.090，95%Cr(0.039，0.21)]；髓内针的不愈合率结果无统计学差异[RR=0.28，95%Cr(0.02，2.2)]，见图6a。网状分析结果显示，锁定钢板的不愈合率要优于吊带，差异具有统计学意义[logRR=1.958，95%Cr(1.248，2.845)]；非锁定钢板的不愈合率要优于吊带，差异具有统计学意义[logRR=1.952，95%Cr(1.335，2.616)]；弹性髓内钉的不愈合率要优于吊带，差异具有统计学意义[logRR=2.404，95%Cr(1.574，3.239)]；锁定钢板的不愈合率要优于8字绷带，差异具有统计学意义[logRR=2.321，95%Cr(0.432，4.453)]；非锁定钢板的不愈合率要优于8字绷带，差异具有统计学意义[logRR=2.294，95%Cr(0.727，4.27)]；弹性髓内钉的不愈合率要优于8字绷带，差异具有统计学意义[logRR=2.803，95%Cr(0.821，4.816)]。其余治疗方法不愈合率的比较结果都没有统计学差异，见表3左下。不愈合率的概率排序：通过对排序图中的柱状图进行评估分析，将所涉及的干预措施进行概率排序，结果显示：优劣顺序为弹性髓内钉、非锁定钢板、锁定钢板、髓内针、吊带、8字绷带，见图6b。不愈合率的节点拆分分析：通过节点拆分来评价锁骨中段移位性骨折的不愈合率不一致性，当P < 0.05时，说明各研究直接与间接比较结果间不一致。当锁定钢板对比吊带时，P=0.949 3；当非锁定钢板对比吊带时，P=0.315 95；当弹性髓内钉对比吊带时，P=0.366 55；当弹性髓内钉对比锁定钢板时，P=0.941 75；当弹性髓内钉对比非锁定钢板时，P=0.337 05，见图6c。"

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