Neer II型锁骨远端骨折是否修复喙锁韧带的荟萃分析

A meta-analysis on internal fixation with or without repair of coracoclavicular ligament for Neer type II distal clavicular fractures

摘要:

［目的］ 运用荟萃分析评价锁定钢板治疗 Neer II 型锁骨远端骨折修复与未修复喙锁韧带的疗效。［方法］ 计算机检索知网、万方、维普、SinoMed、Pubmed、Embase、The Cochrane library 和 Web of Science 等数据库相关文献并提取数据，采用 Review Manager 5.3 软件进行荟萃分析。［结果］ 共纳入 10 项研究 385 例患者，其中未修复组 191 例，修复组 194 例。荟萃分析结果显示：与未修复组相比，修复组手术时间长 （MD=8.23，95%CI 3.81~12.66，P<0.001）、术中出血量大 （MD=18.81， 95%CI 13.79~23.83，P<0.001）、术后喙锁间距小 （MD=1.06，95%CI 0.41~1.72，P<0.001）、Constant-Murley 肩关节评分高 （MD=7.92，95%CI 3.53~12.30，P<0.001），而两组肩关节 UCLA 评分、DASH 上肢功能评分、骨折愈合时间和术后相关并发症发生率的差异均无统计学意义（P>0.05）。［结论］锁定钢板联合修复喙锁韧带较未修复治疗锁骨远端 NeerⅡ型骨折，虽手术时间更长，术中出血量较多，但术后喙锁间距更小，Constant-Murley 肩关节评分更优。

Abstract:

[Objective] To evaluate the clinical outcomes of locking-plate internal fixation with or without coracoclavicular ligament re- pair for Neer type II distal clavicular fractures by a meta- analysis. [Methods] The relevant literatures of the CNKI, Wanfang, VIP, SinoMed, Pubmed, Embase, Cochrane Library and Web of Science were searched. Subsequently, the data were extracted and a meta-analy- sis was conducted by using Review Manager 5.3 software. [Results] A total of 385 patients were enrolled involving 10 studies, including 191 patients in the unrepaired group and 194 patients in the repaired group. As results of the meta-analysis, the repair group had signifi- cantly longer operation time (MD=8.23, 95%CI 3.81~12.66, P＜0.001) , significantly larger amount of intraoperative blood loss (MD=18.81, 95%CI 13.79~23.83, P＜0.001) , whereas significantly higher Constant-Murley score (MD=7.92, 95%CI 3.53~12.30, P＜0.001) , and signif- icantly less postoperative coracoclavicular distance (MD=1.06, 95%CI 0.41~1.72, P＜0.001) than the non- repair group. However, there were no significant differences in UCLA score, DASH score, fracture healing time, and incidence of postoperative complications between the two groups (P＞0.05) . [Conclusion] The coracoclavicular ligament repair combined with locking- plate internal fixation does achieve considerably better clinical outcomes than the counterpart without coracoclavicular ligament repair for Neer type II distal clavicular frac- tures in terms of Constant-Murley score and coracoclavicular interval postoperatively, regardless of longer operation time and more intraop- erative blood loss.