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中华肩肘外科电子杂志 ›› 2023, Vol. 11 ›› Issue (01) : 53 -62. doi: 10.3877/cma.j.issn.2095-5790.2023.01.009

论著

解剖锁定板是否联合带线锚钉重建喙锁韧带治疗不稳定性锁骨远端骨折疗效的Meta分析
刘泽民1, 张经2, 王栋1, 李岩1, 常诗语1, 张永红1,()   
  1. 1. 030001 太原,山西医科大学第二医院骨科
    2. 550025 贵阳,贵州医科大学
  • 收稿日期:2022-09-12 出版日期:2023-02-05
  • 通信作者: 张永红
  • 基金资助:
    国家自然科学基金面上项目(82172439)

Meta-analysis of the efficacy of simple anatomical locking plate combined with coracoclavicular ligament reconstruction in the treatment of unstable distal clavicle fractures

Zemin Liu1, Jing Zhang2, Dong Wang1, Yan Li1, Shiyu Chang1, Yonghong Zhang1,()   

  1. 1. Department of Orthopedics, The Second Hospital of Shanxi Medical University, Taiyuan 030001, China
    2. Guizhou Medical University, Guiyang 550025, China
  • Received:2022-09-12 Published:2023-02-05
  • Corresponding author: Yonghong Zhang
引用本文:

刘泽民, 张经, 王栋, 李岩, 常诗语, 张永红. 解剖锁定板是否联合带线锚钉重建喙锁韧带治疗不稳定性锁骨远端骨折疗效的Meta分析[J/OL]. 中华肩肘外科电子杂志, 2023, 11(01): 53-62.

Zemin Liu, Jing Zhang, Dong Wang, Yan Li, Shiyu Chang, Yonghong Zhang. Meta-analysis of the efficacy of simple anatomical locking plate combined with coracoclavicular ligament reconstruction in the treatment of unstable distal clavicle fractures[J/OL]. Chinese Journal of Shoulder and Elbow(Electronic Edition), 2023, 11(01): 53-62.

目的

通过Meta分析比较解剖锁定板内固定联合与不联合带线锚钉重建喙锁韧带(reconstruction of coracoclavicular ligament with thread anchor,RCLTA)治疗不稳定性锁骨远端骨折疗效的差异。

方法

计算机检索PubMed、Embase、Cochrane图书馆、中国知网、万方和维普数据库,并辅以手工检索,收集自建库至2022年6月所有比较解剖锁定板内固定联合与不联合RCLTA治疗不稳定性锁骨远端骨折的随机对照研究或病例对照研究。严格评价纳入研究的文献质量,并提取相关数据资料(切口长度、手术时间、术中出血量、住院时间、骨折愈合时间、术后并发症、末次随访喙锁间距、末次随访Costant-Murley肩关节功能评分),运用RevMan5.4软件进行Meta分析。

结果

共纳入8篇回顾性队列研究,患者共279例。其中重建组行解剖锁定板内固定联合喙锁韧带(coracoclavicular,CC)重建138例,非重建组行单纯解剖锁定板内固定141例。Meta分析结果显示:非重建组手术时长短于重建组[MD =8.88,95% CI(3.76,13.99),P<0.05],末次随访喙锁间距大于重建组[MD =-0.43,95% CI(-0.66,-0.20),P<0.05],末次随访Costant-Murley肩关节功能评分低于重建组[MD=4.67,95%CI(1.52,7.82),P<0.05],骨折愈合时间长于重建组[MD =-0.98,95% CI(-1.94,-0.02),P=0.04]。而非重建组与重建组在切口长度[MD =0.34,95% CI(-0.17,0.86),P=0.19]、住院时间[MD =-0.69,95% CI(-1.51,0.12),P=0.10]、术中出血量[MD =11.66,95% CI(-2.31,25.63),P=0.10]及术后并发症[OR =1.07,95% CI(0.42,2.71),P=0.89]方面的比较,差异均无统计学意义。

结论

与单纯解剖锁定板内固定相比,解剖锁定板联合RCLTA治疗不稳定性锁骨远端骨折末次随访喙锁间距小、Costant-Murley肩关节功能评分高、骨折愈合时间短、联合RCLTA疗效确切,是一种有效的治疗选择。该结论有待于进一步前瞻性、大样本随机对照研究的验证。

Background

The clavicle is the frame bone that connects the upper limbs and the trunk, and clavicle fractures account for about 2.6% of all fractures in the whole body. Distal clavicle fractures occur in the lateral 1/3 of the clavicle, accounting for about 21%-28% of all clavicle fractures. The modified Neer classification divides distal clavicle fractures into types I to V according to the relationship between the fracture line, the coracoclavicular ligament (CC), and the acromioclavicular joint. Neer I, III, and IV fractures can achieve an excellent curative effect through non-surgical treatment of the affected limb suspension brace; Neer II and V types are unstable fractures with large displacement, and non-operative treatment of nonunion High incidence, often choose surgery. Relevant studies have shown that 68% of the fixation methods use anatomical locking plates, which may be related to its advantages of fitting the shape of the distal clavicle, stably fixing minor fractures, and allowing early movement of the affected arm. Complications such as shoulder joint pain are more common, and the current use is gradually decreasing. Unstable distal clavicle fractures are often accompanied by a coracoclavicular ligament injury, which causes stress concentration in the distal clavicle. Whether an anatomical locking plate should be combined with CC reconstruction to relieve distal stress is still controversial. Some scholars believe that when the locking plate remains stable, the CC will heal in a tension-free state, and the strength is close to that of normal ligaments. No other CC reconstruction is required, and an excellent curative effect can be obtained by simple anatomical locking plate fixation. Other scholars believe that the injury of the coracoclavicular ligament leads to severe displacement of the fracture end and increases the chance of nonunion after surgery. Therefore, anatomical locking plate fixation combined with CC reconstruction is advocated for treatment. Objective Meta-analysis was used to compare the efficacy of anatomical locking plate internal fixation combined with and without CC reconstruction in treating unstable distal clavicle fractures.

Methods

We used computers to search PubMed, Embase, Cochrane Library, CNKI, WanFang Data, and VIP databases, supplemented by manual search, and collected all comparisons of anatomical locking plate internal fixation with and without CC reconstruction from the self-built database to June 2022. Randomized controlled or case-control studies of stable distal clavicle fractures. The quality of the literature included in the included studies was strictly evaluated, and relevant data were extracted (incision length, operation time, intraoperative blood loss, hospital stay, fracture healing time, postoperative complications, coracoclavicular distance at last follow-up, Constant-Murley shoulder joint at last follow-up) Functional score), and Meta-analysis was performed using RevMan5.4 software.

Results

A total of 8 retrospective cohort studies with 279 patients were included. One hundred thirty-eight cases underwent anatomical locking plate internal fixation combined with CC reconstruction in the reconstruction group, and 141 cases underwent simple anatomical locking plate internal fixation in the non-reconstruction group. Meta-analysis results showed that the operation time in the non-reconstruction group was shorter than that in the reconstruction group [MD=8.88, 95% CI (3.76, 13.99), P<0.05], and the coracoclavicular distance at the last follow-up was greater than that in the reconstruction group [MD=-0.43, 95% CI (-0.66, -0.20), P<0.05], the Constant-Murley shoulder joint function score at the last follow-up was lower than that in the reconstruction group [MD=4.67, 95% CI (1.52, 7.82), P<0.05], and the fracture healing time was longer than that in the reconstruction group [MD=-0.98, 95% CI (-1.94, -0.02), P=0.04]. In the non-reconstruction group and the reconstruction group, the incision length [MD=0.34, 95% CI (-0.17, 0.86), P=0.19], hospital stay [MD=-0.69, 95% CI (-1.51, 0.12), P=0.10], intraoperative blood loss [MD=11.66, 95% CI (-2.31, 25.63), P=0.10] and postoperative complications [OR=1.07, 95% CI (0.42, 2.71), P=0.89] The differences were not statistically significant.

Conclusion

Compared with internal fixation with anatomical locking plate alone, anatomical locking plate combined with CC reconstruction in the treatment of unstable distal clavicle fractures has a smaller coracoclavicular distance, higher Constant-Murley shoulder joint function score, and shorter fracture healing time at the last follow-up and effective treatment option. This conclusion needs to be verified by further prospective, large-sample randomized controlled studies.

图1 文献纳入流程图
表1 纳入文献的基本特征
表2 纳入文献NOS量表评分
图2 重建组与非重建组切口长度比较的森林图
图3 重建组与非重建组手术时间比较的森林图
图4 重建组与非重建组住院时间比较的森林图
图5 重建组与非重建组术中出血量比较的森林图
图6 重建组与非重建组骨折愈合时间比较的森林图
图7 重建组与非重建组术后并发症比较的森林图
图8 重建组与非重建组末次随访喙锁间距比较的森林图
图9 重建组与非重建组末次随访Costant-Murley肩关节功能评分比较的森林图
图10 发表偏倚漏斗图 图A:手术时间漏斗图;图B:术后并发症漏斗图;图C:末次随访喙锁间距漏斗图
[1]
Sambandam B, Gupta R, Kumar S, et al. Fracture of distal end clavicle: A review[J]. J Clin Orthop Trauma, 2014,5(2):65-73.
[2]
方加虎,唐国龙,陈浩,等.喙锁韧带的解剖学重建治疗锁骨远端骨折的疗效观察[J].中华医学杂志,2017,97(13):1011-1014.
[3]
Craig EV. Fractures of the clavicle[M]. Philadelphia: WB Saunders, 1990: 1109-1193.
[4]
Kim DW, Kim DH, Kim BS, et al. Current concepts for classification and treatment of distal clavicle fractures[J]. Clin Orthop Surg, 2020,12(2):135-144.
[5]
Ying H, Wang J, Sun Y, et al. Treatment of unstable distal clavicle fractures (Neer type IIb): a modified system using a miniature locking plate with a single button[J]. J Int Med Res, 2021,49(6):1-10.
[6]
Katayama Y, Takegami Y, Tokutake K, et al. Comparison of functional outcome and complications of locking plate versus coracoclavicular fixation in the treatment of unstable distal clavicle fractures: the multicenter, propensity-matched TRON study[J]. Eur J Orthop Surg Traumatol, 2022,15:1-7.
[7]
Shin SJ, Ko YW, Lee J, et al. Use of plate fixation without coracoclavicular ligament augmentation for unstable distal clavicle fractures[J]. J Shoulder Elbow Surg, 2016,25(6):942-948.
[8]
Vaishya R, Vijay V, Khanna V. Outcome of distal end clavicle fractures treated with locking plates[J]. Chin J Traumatol, 2017,20(1):45-48.
[9]
Fleming MA, Dachs R, Maqungo S, et al. Angular stable fixation of displaced distal-third clavicle fractures with superior precontoured locking plates[J]. J Shoulder Elbow Surg,2015,24(5):700-704.
[10]
Lee SK, Lee JW, Song DG, et al. Precontoured locking plate fixation for displaced lateral clavicle fractures[J]. Orthopedics,2013,36(6):801-807.
[11]
Han L, Hu Y, Quan R, et al. Treatment of Neer IIb Distal Clavicle Fractures Using Anatomical Locked Plate Fixation With Coracoclavicular Ligament Augmentation[J]. J Hand Surg Am,2017,42(12):e1-e6.
[12]
Xu Y, Guo X, Peng H, et al. Different internal fixation methods for unstable distal clavicle fractures in adults: a systematic review and network meta-analysis[J]. J Orthop Surg Res,2022,17(1):43.
[13]
Schliemann B, Roßlenbroich SB, Schneider KN, et al. Surgical treatment of vertically unstable lateral clavicle fractures (Neer 2b) with locked plate fixation and coracoclavicular ligament reconstruction[J]. Arch Orthop Trauma Surg,2013,133(7):935-939.
[14]
Xie Z, Song M, Zhou J, et al. Precontoured Locking Compression Plate with Titanium Alloy Cable System: In Treatment of Neer Type IIb Distal Clavicle Fracture[J]. Orthop Surg,2021,13(2):451-457.
[15]
Peterson J, Welch V, Losos M, et al. The Newcastle-ottawa scale (NOS) for assessing the quality of nonrandomised studies in meta-analyses[J]. Ottawa Hospital Research Institute, 2011, 2(1): 1-12.
[16]
马昌科, 沈忆新, 阳利武. 单纯解剖锁定钢板内固定与联合喙锁韧带重建治疗新鲜和陈旧性Neer IIb型锁骨远端骨折的疗效比较[J]. 中华创伤骨科杂志, 2022, 24(2):120-126.
[17]
Salazar BP, Chen MJ, Bishop JA, et al. Outcomes after locking plate fixation of distal clavicle fractures with and without coracoclavicular ligament augmentation[J]. Eur J Orthop Surg Traumatol,2021,31(3):473-479.
[18]
Xu H, Chen WJ, Zhi XC, et al. Comparison of the efficacy of a distal clavicular locking plate with and without a suture anchor in the treatment of Neer IIb distal clavicle fractures[J]. BMC Musculoskelet Disord, 2019,20(1):503.
[19]
张玉富, 米萌, 张健, 等. 单独锁定钢板和锁定钢板联合缝合锚治疗不稳定型锁骨远端骨折的病例对照研究[J]. 中国骨伤, 2019,32(1):11-16.
[20]
王传宇, 史宗新, 于远洋, 等. 联合带线锚钉功能重建锁骨远端Neer Ⅱ b型骨折中喙锁韧带的意义[J/CD]. 中华肩肘外科电子杂志, 2018,6(2):120-124.
[21]
汤红伟, 殷勇, 韩擎天, 等. 解剖锁定钢板内固定联合喙锁韧带重建治疗Neer Ⅱb型锁骨远端骨折的疗效研究[J]. 中国修复重建外科杂志, 2018,32(9):1181-1186.
[22]
Fan J, Zhang Y, Huang Q, et al. Comparison of Treatment of Acute Unstable Distal Clavicle Fractures Using Anatomical Locking Plates with Versus without Additional Suture Anchor Fixation[J]. Med Sci Monit, 2017,23:5455-5461.
[23]
曾金才, 朱立帆, 吴卫东, 等. 喙锁固定联合解剖锁定板治疗不稳定锁骨远端骨折的疗效[J]. 中华创伤杂志, 2017, 33(3):263-267.
[24]
Kim DJ, Lee YM, Yoon EJ, et al. Comparison of Locking Plate Fixation and Coracoclavicular Ligament Reconstruction for Neer Type 2B Distal Clavicle Fractures[J]. Orthop J Sports Med202210(3):1-9.
[25]
Wang HK, Liang LS, He RG, et al. Comparative analysis of locking plates versus hook plates in the treatment of Neer type II distal clavicle fractures[J]. J Int Med Res, 2020,48(4):1220717612.
[26]
Fox HM, Ramsey DC, Thompson AR, et al. Neer Type-II Distal Clavicle Fractures: A Cost-Effectiveness Analysis of Fixation Techniques[J]. J Bone Joint Surg Am, 2020,102(3):254-261.
[27]
Li L, Li TY, Jiang P, et al. Clavicle hook plate versus distal clavicle locking plate for Neer type II distal clavicle fractures[J]. J Orthop Surg Res, 2019,14(1):472.
[28]
薛骋, 徐海波, 宋李军, 等. 喙锁韧带完全解剖重建的钻孔技术研究[J]. 中华创伤骨科杂志, 2015, 17(4):337-341.
[29]
郑兴国, 薛骋, 李翔, 等. 喙锁韧带解剖重建与钩钢板治疗锁骨远端Neer Ⅱb型骨折的疗效比较[J]. 中华创伤骨科杂志, 2022, 24(5):421-428.
[30]
Kashii M, Inui H, Yamamoto K. Surgical treatment of distal clavicle fractures using the clavicular hook plate[J]. Clin Orthop Relat Res, 2006,447:158-164.
[31]
Zhang C, Huang J, Luo Y, et al. Comparison of the Efficacy of a Distal Clavicular Locking Plate Versus a Clavicular Hook Plate in the Treatment of Unstable Distal Clavicle Fractures and a Systematic Literature Review[J]. Int Orthop, 2014,38(7):1461-1468.
[32]
Seyhan M, Kocaoglu B, Kiyak G, et al. Anatomic locking plate and coracoclavicular stabilization with suture endo-button technique is superior in the treatment of Neer Type II distal clavicle fractures[J]. Eur J Orthop Surg Traumat, 2015,25(5):827-832.
[33]
Madsen W, Yaseen Z, LaFrance R, et al. Addition of a suture anchor for coracoclavicular fixation to a superior locking plate improves stability of type IIB distal clavicle fractures[J]. Arthroscopy, 2013,29(6):998-1004.
[34]
Bishop JY, Roesch M, Lewis B, et al. A biomechanical comparison of distal clavicle fracture reconstructive techniques[J]. Am J Orthop (Belle Mead NJ), 2013,42(3):114-118.
[35]
Rieser GR, Edwards K, Gould GC, et al. Distal-third clavicle fracture fixation: a biomechanical evaluation of fixation[J]. J Shoulder Elbow Surg, 2013,22(6):848-855.
[36]
曾金才, 朱立帆, 钱学峰, 等. 钩钢板与解剖锁定板联合喙锁缝线固定治疗锁骨远端骨折的比较[J]. 中国矫形外科杂志, 2018,26(24):2225-2229.
[37]
吴剑宏, 吴晓明, 韩志华, 等. 喙锁韧带重建结合钢板固定治疗伴喙锁韧带锁骨止点撕脱的锁骨远端骨折[J]. 中华骨科杂志, 2020,40(1):17-18.
[38]
Furuhata R, Matsumura N, Udagawa K, et al. Residual coracoclavicular separation after plate fixation for distal clavicle fractures: comparison between fracture patterns[J]. JSES Int2021,5(5):840-845.
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