CAJ | 학술논문

背景：目前已有大量研究证实，重建钢板相较于克氏针修复锁骨骨折具有较好的效果，但其具体优越性目前尚无确切报道，且临床上随机对照研究较少，缺乏系统性评价。目的：采用Meta分析的方法对重建钢板和克氏针修复锁骨骨折的疗效和安全性进行系统评价。方法：通过计算机检索2008至2015年MEDLINE、Embase、PubMed、Cochrane图书馆、CNKI、万方数据库、维普数据库，搜集有关重建钢板与克氏针修复锁骨骨折的对照研究，筛选出符合纳入标准的文献，对其进行严格的质量评价，选择疗效优良率、切口延期愈合、畸形愈合、术后感染、内固定物松动、术后骨折移位、手术时间、术中出血量、骨折愈合时间作为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。结果与结论：最终纳入12篇文献，共911例患者，发表时间为2008至2014年，全部为中文文献。Meta分析结果显示，与克氏针相比，重建钢板修复锁骨骨折在提高疗效优良率、缩短切口延期愈合、减少畸形愈合、降低术后感染、防止内固定物松动、避免术后骨折移位方面具有一定的优越性，但两种方法修复锁骨骨折在手术时间、术中出血量、骨折愈合时间方面差异无显著性意义。提示与克氏针相比，重建钢板修复锁骨骨折具有较好的效果，在患者自身经济以及医院条件允许的情况下可优先选择重建钢板修复锁骨骨折。由于文章纳入病例有限，缺乏设计更为严格的多中心、大样本、长期的临床随机对照研究来进一步证实结论可信度。
배경：목전이유대량연구증실，중건강판상교우극씨침수복쇄골골절구유교호적효과，단기구체우월성목전상무학절보도，차림상상수궤대조연구교소，결핍계통성평개。목적：채용Meta분석적방법대중건강판화극씨침수복쇄골골절적료효화안전성진행계통평개。방법：통과계산궤검색2008지2015년MEDLINE、Embase、PubMed、Cochrane도서관、CNKI、만방수거고、유보수거고，수집유관중건강판여극씨침수복쇄골골절적대조연구，사선출부합납입표준적문헌，대기진행엄격적질량평개，선택료효우량솔、절구연기유합、기형유합、술후감염、내고정물송동、술후골절이위、수술시간、술중출혈량、골절유합시간작위Meta분석적평개지표，이용Cochrane협작망제공적RevMan 5.2연건대납입연구결과진행Meta분석。결과여결론：최종납입12편문헌，공911례환자，발표시간위2008지2014년，전부위중문문헌。Meta분석결과현시，여극씨침상비，중건강판수복쇄골골절재제고료효우량솔、축단절구연기유합、감소기형유합、강저술후감염、방지내고정물송동、피면술후골절이위방면구유일정적우월성，단량충방법수복쇄골골절재수술시간、술중출혈량、골절유합시간방면차이무현저성의의。제시여극씨침상비，중건강판수복쇄골골절구유교호적효과，재환자자신경제이급의원조건윤허적정황하가우선선택중건강판수복쇄골골절。유우문장납입병례유한，결핍설계경위엄격적다중심、대양본、장기적림상수궤대조연구래진일보증실결론가신도。
BACKGROUND:At present, a large number of studies have confirmed that reconstruction plate compared to Kirschner wire in the treatment of clavicular fracture showed good effects, but there is no precise report on the specific advantages at present. Clinical randomized controled study is less, and lacks of systematic evaluation. OBJECTIVE:To systematicaly evaluate the efficacy and safety of the treatment of the clavicle fractures with the reconstruction plate and the Kirschner wire by using a meta-analysis. METHODS: We retrieved the MEDLINE, Embase, PubMed, Cochrane library, CNKI, Wanfang database and VIP database from 2008 to 2015 by computer to colect al controled study relevant to reconstruction plate and Kirschner wire in the treatment of clavicle fracture, and screened the literatures that met the inclusion criteria. Al literatures were analyzed in strict quality evaluation. Excelent rate, delayed healing of incision, malunion, postoperative infection, loosening of internal fixation, postoperative fracture displacement, operation time, intraoperative bleeding volume and fracture healing time were selected as the evaluation indexes of a meta-analysis. Meta-analysis was performed with RevMan 5.2 software from the Cochrane Colaboration. RESULTS AND CONCLUSION:Finaly 12 Chinese articles published from 2008 to 2014 were included, with 911 patients. Meta-analysis results showed that compared with Kirschner wire, the reconstruction plate has a certain advantage in improving the excelent and good rate, shortening the delayed wound healing and reducing deformity healing, reducing postoperative infection, preventing the loosening of internal fixation and avoiding postoperative fracture displacement. However, the two surgical methods in the treatment of clavicular fracture were not significant in operation time, intraoperative blood loss and fracture healing time. These results suggest that compared with the Kirschner wire, reconstruction plate fixation for treatment of clavicular fracture had better curative effect. The reconstruction plate can be firstly selected in the permit of patient economic conditions and hospital conditions. Due to the limited sample size in this study, the multicenter, large-sample and long-term clinical randomized controled studies with more strict design are needed to increase the reliability of the evidence.