Klavikula kırığına yapılan cerrahi vecerrahi dışı girişimlerin değerlendirilmesi

Öz

Amaç:Bu çalışmanın amacı, tüm sistematik inceleme ve meta-analizleri gözden geçirmek ve klavikula kırıklarına yapılan girişimlerin etkinliğini kanıtlayan bir özet sunmak idi.

Çalışma planı: Cochrane Library, PubMed, MEDLINE, Chinese BioMedicine veri tabanı, Çin Akademik Dergiler Tam Metin (China Academic Journals Full-text) Veri Tabanı, VIP Çin Bilim ve Teknoloji Süreli Yayınlar (Chinese Science and Technology Periodicals) Veri Tabanı ve Wanfang Veri Tabanı klavikula kırıklarıyla ilgili anahtar sözcükler kullanılarak, uygun çalışmalar için tarandı. Çalışmaya dahil edilen çalışmaların metodolojik kalitesi AMSTAR değerlendirme aracı kullanılarak değerlendirildi. Direkt kanıtlar anlatı analizi ile incelendi. Randomize kontrollü çalışmalar meta-analiz için tekrar havuzda toplandı. Özet sonuçlarında GRADE yaklaşımı kullanıldı.

Bulgular: Toplanan verilerin sonuçları cerrahi girişimin cerrahi dışı girişimlere yöntemlerine göre daha az kaynamama ve hatalı kaynama ile daha yüksek hasta memnuniyeti sağladığını [RO=6.57, %95 GA (3.01, 14.35), RO=6.93, %95 GA (2.99, 16.09); RO=0.68, %95 GA (0.51, 0.90)] gösterdiği halde, bu 3 sonuç düşük kaliteli kanıtlara dayanmaktaydı. Farklı cerrahi ve cerrahi dışı yöntemler arasında bir fark saptanmadı.

Çıkarımlar: Cerrahi girişim, kaynamama ve hatalı kaynama oranları ile hasta memnuniyeti açısından cerrahi dışı girişime göre daha etkili bir yaklaşımdır. Girişim yöntemlerinin etkinliğini karşılaştıran kanıt kalitesi genel olarak düşük olduğundan, bu konuda daha fazla orijinal çalışmaya ihtiyaç vardır.

Anahtar Kelimeler

• Cerrahi dışı girişim; cerrahi girişim; klavikula kırığı; GRADE; incelemelerin özeti; sistematik inceleme.

Evaluation of surgical and non-surgical interventions for clavicle fractures

Abstract

Objective:The aim of this study was to review all systematic reviews and meta-analyses and provide an overview of the evidence of efficacy of interventions for clavicle fractures.

Methods: The Cochrane Library, PubMed, MEDLINE, Chinese Biomedicine database, China Academic Journals Full-text Database, VIP Chinese Science and Technology Periodicals Database and Wanfang Database were searched for eligible studies using keywords related to clavicle fractures. The methodological quality of included studies was assessed using the AMSTAR assessment tool. Direct evidence was analyzed narratively. Randomized controlled trials were pooled again for meta-analysis. The GRADE approach was used in summary conclusions.

Results: The result of pooled data showed that while operative treatment had lower nonunion and malunion rates and higher patient satisfaction than non-operative treatment modalities [RR=6.57, 95% CI (3.01, 14.35), RR=6.93, 95% CI (2.99, 16.09); RR=0.68, 95% CI (0.51, 0.90)], these 3 outcomes were based on low-quality evidence. There was no difference between dissimilar operative and dissimilar non-operative treatments.

Conclusion: Operative treatment is more effective than non-operative treatment in terms of nonunion and malunion rates and patient satisfaction. As the quality of evidence comparing efficacy between intervention methods is generally low, further original studies are needed.

Keywords

• Clavicle fracture
• GRADE
• non-operative treatment
• operative treatment
• overview of reviews
• systematic review

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