■各种钢板类型用于移位锁骨中段骨折的手术治疗。这些板可以定位在锁骨上的不同位置,尽管迄今为止还没有研究阐明最佳的钢板类型和固定位置。本系统评价通过对钢板类型和位置进行分层,比较了使用钢板固定治疗移位锁骨中段骨折的功能结果和并发症。
根据系统评价和荟萃分析指南的首选报告项目进行系统评价,以确定所有报告功能结果的论文。工会费率,和/或使用钢板治疗锁骨中段骨折的并发症。从开始到2022年3月,搜索了多个数据库和试验登记册。对功能结局和并发症类型进行了荟萃分析,按板类型分层(锁定,压缩,或重建)和位置(上或下)。使用随机效应模型计算功能结果评分和并发症发生率的汇总估计值。使用偏倚风险版本2和ROBINS-I(非随机研究中的偏倚风险-干预)工具评估偏倚风险和质量。对估计的信心是根据评级的建议(建议的评级,评估,发展,和评价)工作组。
■45项研究纳入系统评价,43项纳入荟萃分析。根据板的类型和位置,12个月时,合并的Constant-Murley评分范围为89.23至93.48。上锁定钢板(等级低)的骨不愈合率为3%(95%置信区间[CI]1-6)。任何并发症的发生率(骨不连,硬件故障,硬件刺激,伤口裂开,瘢痕疙瘩,浅表感染,深部感染,延迟工会,malunion,和/或持续性疼痛)按板类型和位置划分,范围为3%至17%(等级非常低至中度)。上加压钢板的并发症发生率最高(17%[95%CI5-44],等级很低),而前下加压钢板的并发症发生率最低(3%[95%CI0-15],等级很低)。硬件刺激是上锁定板和上加压板报告最多的个体并发症。11%(95%CI7-17,等级低)和11%(95%CI3-33,等级非常低),分别。
■尽管大多数研究质量低,报告功能结局的研究通常显示出良好的功能结果和相似的并发症发生率,无论钢板类型和位置如何.没有证据表明钢板和位置组合可以优化患者功能结果或并发症。我们无法可靠地评估大多数按位置分层的钢板类型的愈合率或个体并发症。
UNASSIGNED: Various plate types are used in the surgical treatment of displaced midshaft clavicle fractures. These plates can be positioned in different locations on the clavicle, although no studies to date have elucidated optimal plate type and location of fixation. This systematic review compares the functional outcomes and complications in the management of displaced midshaft clavicle fractures using plate fixation by stratifying by both plate type and location.
UNASSIGNED: A systematic review according to Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines was conducted to identify all papers reporting functional outcomes, union rates, and/or complications using plates for the management of midshaft clavicle fractures. Multiple databases and trial registries were searched from inception until March 2022. A meta-analysis was conducted for functional outcomes and type of complication, stratified by plate type (locking, compression, or reconstruction) and location (superior or anteroinferior). Pooled estimates of functional outcome scores and incidence of complications were calculated using a random effects model. Risk of bias and quality were assessed using the risk of bias version 2 and ROBINS-I (Risk Of Bias In Non-randomised Studies - of Interventions) tools. The confidence in estimates were rated and described according to the recommendations of the GRADE (Grading of Recommendations, Assessment, Development, and Evaluations) working group.
UNASSIGNED: Forty-five studies were included in the systematic review and 43 were included in the meta-analysis. Depending on plate type and location, pooled Constant-Murley Scores ranged from 89.23 to 93.48 at 12 months. Nonunion rates were 3% (95% confidence interval [CI] 1-6) for superior locking plates (GRADE Low). Rates of any complication (nonunion, hardware failure, hardware irritation, wound dehiscence, keloid, superficial infection, deep infection, delayed union, malunion, and/or persistent pain) by plate type and location ranged from 3% to 17% (GRADE Very Low to Moderate). Superior compression plates had the highest incidence of any complications (17% [95% CI 5-44], GRADE Very Low), while anterior inferior compression plates had the lowest incidence of any complication (3% [95% CI 0-15], GRADE Very Low). Hardware irritation was the most reported individual complication for superior locking plates and superior compression plates, 11% (95% CI 7-17, GRADE Low) and 11% (95% CI 3-33, GRADE Very Low), respectively.
UNASSIGNED: Although most studies were of low quality, studies reporting functional outcomes generally showed good functional results and similar incidence of any complication regardless of plate type and location. There is no evidence of a plate and location combination to optimize patient functional outcomes or complications. We were unable to reliably evaluate union rates or individual complications for most plate types stratified by location.