Endobutton钢板与锁骨钩钢板治疗肩锁关节脱位优良率及并发症的Meta分析
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摘要
背景:目前修复肩锁关节脱位的方式很多,主要以锁骨钩钢板为主,但解剖重建肩锁韧带的斜方和锥状韧带是治疗肩锁关节脱位的最主要趋势。Endobutton钢板作为近年来被广泛推广的修复方式,根据大量的随机对照试验及回顾性研究结果示,其具有较锁骨钩钢板更好的疗效和更低的并发症发生率。目的:对Endobutton钢板与锁骨钩钢板治疗肩锁关节脱位的优良率及短期并发症发生率进行系统评价。方法:检索Cochrane library(1966年6月至2017年5月)、Pub Med(1966年6月至2017年5月)、MEDLINE(1966年2月至2017年5月)、EMbase(1984年1月至2017年5月)、中国知网(1979年1月至2017年5月)、维普(1989年1月至2017年5月)、万方(1982年1月至2017年5月)等数据库;同时手工检索6种中文主要骨科杂志,并查阅相关文章所附的参考文献。收集所有Endobutton钢板与锁骨钩钢板治疗肩锁关节脱位的随机对照试验,筛选出符合纳入标准的文献,对其进行严格的质量评价,由Rev Man 5.3软件对所有结局指标进行Meta分析。结果与结论:(1)最终纳入13篇随机对照试验,共800例患者,其中Endobutton钢板试验组394例,锁骨钩钢板对照组406例。其中只有1个研究为3种不同方式比较,其余均为Endobutton钢板与锁骨钩钢板比较;(2)Meta分析表明,Endobutton钢板治疗肩锁关节脱位的疗效优良率优于锁骨钩钢板(P<0.000 01);与锁骨钩钢板比较,Endobutton钢板在切口感染、肩锁关节疼痛、活动受限、再脱位方面的发生率均较低(P=0.02,P<0.001,P<0.000 01,P=0.03);(3)提示Endobutton钢板对肩锁关节脱位的修复效果优于锁骨钩钢板,且其切口感染、肩锁关节疼痛、活动受限、再脱位的发生率更低。虽文章纳入的随机对照试验较多,但文章质量有限,尚需设计更为严格的大样本随机对照试验来增加证据的可信度。
BACKGROUND: At present, there are many ways to treat acromioclavicular joint dislocation, mainly based on clavicular hook plate, but the anatomical reconstruction of the trapezoid ligament and conoid ligament of the acromioclavicular ligament is the most important trend in the treatment of acromioclavicular joint dislocation. Endobutton plate has been widely promoted in recent years. A large number of randomized controlled trials and retrospective study showed that it has better efficacy and lower incidence of complications compared with the clavicular hook plate. OBJECTIVE: To evaluate the excellent and good rate and the short-term incidence of complication between Endobutton plate and clavicular hook plate in the treatment of acromioclavicular joint dislocation. METHODS: The Cochrane Library(1966-06/2017-05), Pub Med(1966-06/2017-05), MEDLINE(1966-02/2017-05), EMbase(1984-01/2017-05), CNKI(1979-01/2017-05), VIP(1989-01/2017-05), and Wanfang(1982-01/2017-05) databases were searched by computer. Simultaneously, six major Chinese orthopedic journals were retrieved by hand, and the references included in the related articles were consulted. Randomized controlled trials addressing Endobutton plates and clavicular hook plates for the treatment of acromioclavicular joint dislocation were collected. The literatures were screened for inclusion criteria, and their qualities were evaluated. Meta-analysis was performed using Rev Man 5.3 software. RESULTS AND CONCLUSION:(1) A total of 13 randomized controlled trials containing 800 patients were included in the study. 394 patients were treated with Endobutton plate and 406 patients with clavicular hook plate as controls. Among which, only one study was compared in three different ways; the rest were compared between Endobutton plate and clavicular hook plate.(2) Meta-analysis showed that the excellent and good rate of Endobutton plate was superior to that of clavicular hook plate in the treatment of acromioclavicular joint dislocation(P < 0.000 01). Compared with clavicular hook plate, the incidence of incision infection, acromioclavicular joint pain, limited activity and redislocation were lower in Endobutton plate(P=0.02, < 0.001, < 0.00001, 0.03).(3) These findings suggested that the effect of Endobutton plate was better than that of clavicular hook plate in the treatment of acromioclavicular joint dislocation. The incidences of incision infection, acromioclavicular joint pain, limited mobility, and redislocation were lower in Endobutton plate than in the clavicular hook plate. Although the article included many randomized controlled trials, the qualities of these articles are limited. We still need to design more strictly large-sample randomized controlled trials to increase the credibility of the evidence.
BACKGROUND: At present, there are many ways to treat acromioclavicular joint dislocation, mainly based on clavicular hook plate, but the anatomical reconstruction of the trapezoid ligament and conoid ligament of the acromioclavicular ligament is the most important trend in the treatment of acromioclavicular joint dislocation. Endobutton plate has been widely promoted in recent years. A large number of randomized controlled trials and retrospective study showed that it has better efficacy and lower incidence of complications compared with the clavicular hook plate. OBJECTIVE: To evaluate the excellent and good rate and the short-term incidence of complication between Endobutton plate and clavicular hook plate in the treatment of acromioclavicular joint dislocation. METHODS: The Cochrane Library(1966-06/2017-05), Pub Med(1966-06/2017-05), MEDLINE(1966-02/2017-05), EMbase(1984-01/2017-05), CNKI(1979-01/2017-05), VIP(1989-01/2017-05), and Wanfang(1982-01/2017-05) databases were searched by computer. Simultaneously, six major Chinese orthopedic journals were retrieved by hand, and the references included in the related articles were consulted. Randomized controlled trials addressing Endobutton plates and clavicular hook plates for the treatment of acromioclavicular joint dislocation were collected. The literatures were screened for inclusion criteria, and their qualities were evaluated. Meta-analysis was performed using Rev Man 5.3 software. RESULTS AND CONCLUSION:(1) A total of 13 randomized controlled trials containing 800 patients were included in the study. 394 patients were treated with Endobutton plate and 406 patients with clavicular hook plate as controls. Among which, only one study was compared in three different ways; the rest were compared between Endobutton plate and clavicular hook plate.(2) Meta-analysis showed that the excellent and good rate of Endobutton plate was superior to that of clavicular hook plate in the treatment of acromioclavicular joint dislocation(P < 0.000 01). Compared with clavicular hook plate, the incidence of incision infection, acromioclavicular joint pain, limited activity and redislocation were lower in Endobutton plate(P=0.02, < 0.001, < 0.00001, 0.03).(3) These findings suggested that the effect of Endobutton plate was better than that of clavicular hook plate in the treatment of acromioclavicular joint dislocation. The incidences of incision infection, acromioclavicular joint pain, limited mobility, and redislocation were lower in Endobutton plate than in the clavicular hook plate. Although the article included many randomized controlled trials, the qualities of these articles are limited. We still need to design more strictly large-sample randomized controlled trials to increase the credibility of the evidence.
引文
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[20]陈继峰.RockwoodⅢ-Ⅴ型肩锁关节脱位的三种治疗方法比较研究[J].现代诊断与治疗,2012,23(4):336-337.
[21]徐卫平.不同内固定方法在肩锁关节骨折脱位治疗中的效果比较[J].现代诊断与治疗,2013,24(19):4500-4501.
[22]孙华,罗轶,毛汉兴,等.锁骨钩钢板与带绊纽扣钢板治疗TossyⅢ型肩锁关节脱位的疗效研究[J].骨科,2011,2(1):44-46.
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[25]陆军,李永刚,吴小涛,等.肩锁钩钢板内固定对肩关节功能的影响[J].中华损伤与修复杂志(电子版),2013,8(1):26-30.
[26]郭丹,周海斌.锁骨钩钢板治疗RockwoodⅢ型肩锁关节脱位的治疗分析[J].中国矫形外科杂志,2012,20(16):1449-1451.
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[29]Struhl S,Wolfson TS.Double Endobutton technique for repair of complete acromioclavicular joint dislocations.Tech Shoulder Elbow Surg.2007;8(4):175-179.
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[2]Bradley JP,Elkousy H.Decision making:operative versus nonoperative treatment of acromioclavicular joint injuries.Clin Sports Med.2003;22:277-290.
[3]Spencer EE Jr.Treatment of grade III acromioclavicular joint injuries:a systematic review.Clin Orthop Relat Res.2007;455:38-44.
[4]Wei HF,Chen YF,Zhang CQ,et al.Triple endobuttton technique for the treatment of acute complete acromioclavicular joint dislocations:preliminary results.Int Orthop.2011;35:555-559.
[5]王海明,陈云丰,陆叶,等Triple-Endobutton技术与锁骨钩钢板置入治疗肩锁关节脱位的比较[J].中国组织工程研究,2012,16(17):3105-3110.
[6]Li H,Wang C,Wang J,et al.Restoration of horizontal stability in complete acromioclavicular joint separations:surgical technique and preliminary results.Eur J Med Res.2013;18:42.
[7]宋烜,陈羽,子树明,等.带袢钢板治疗肩锁关节脱位[J].临床骨科杂志,2014,17(1):40-42.
[8]Amarson K,Sigurjionsson K.Acromio-clavicalar dislocation treated by coraoacrom ial iganene transfer.Arch Orthop Trauma Surg.1986;106:8.
[9]Higgins JP,Thompson SG,Deeks JJ,et al.Measuring inconsistency in meta-analyses.BMJ.2003;327(7414):557-560.
[10]冯永增,洪建军,陈鸿亮,等.锁骨钩钢板与双Endobutton钢板治疗肩锁关节脱位的对比研究[J].中华骨科杂志,2009,29(11):1009-1014.
[11]段东东,冯德宏,赵继军,等.Endobutton钢板与锁骨钩钢板治疗TossyⅢ型肩锁关节脱位疗效比较研究[J].中国骨与关节损伤杂志,2013,28(9):828-830.
[12]杨宏涛,贺西京,祝利虎,等.双带袢纽扣钢板重建喙锁韧带治疗完全性肩锁关节脱位疗效观察[J].现代中西医结合杂志,2015,24(19):2122-2124.
[13]张金坤,倪善军.纽扣带袢钢板内固定治疗肩锁关节脱位短期临床分析[J].中外医疗,2016,35(26):83-84.
[14]宋禹.双带袢纽扣钢板重建喙锁韧带治疗完全性肩锁关节脱位疗效分析[J].医学理论与实践,2016,29(10):1327-1328.
[15]谢继勇.锁骨钩钢板与纽扣钢板治疗肩锁关节脱位的临床评价[J].现代医药卫生,2015,31(12):1828-1830.
[16]王家梁,刘志彬,李毅,等.双Endobutton钢板与锁骨钩钢板对TossyⅢ型肩锁关节脱位的临床实效性评价[J].湖北科技学报(医学版),2015,29(2):114-116.
[17]李成,邓伟捷,万雷,等.锁骨钩钢板和双Endobutton带袢钢板治疗TossyⅢ型肩锁关节脱位疗效比较[J].中国民族民间医药,2015,24(5):125-126.
[18]许凌华,徐建杰.不同方法治疗TossyⅢ型肩锁关节脱位的临床比较分析[J].浙江创伤外科,2014,19(6):967-969.
[19]葛兴龙,单军标.Endobutton钢板治疗肩锁关节脱位的疗效分析[J].浙江中医药大学学报,2011,35(5):699-700.
[20]陈继峰.RockwoodⅢ-Ⅴ型肩锁关节脱位的三种治疗方法比较研究[J].现代诊断与治疗,2012,23(4):336-337.
[21]徐卫平.不同内固定方法在肩锁关节骨折脱位治疗中的效果比较[J].现代诊断与治疗,2013,24(19):4500-4501.
[22]孙华,罗轶,毛汉兴,等.锁骨钩钢板与带绊纽扣钢板治疗TossyⅢ型肩锁关节脱位的疗效研究[J].骨科,2011,2(1):44-46.
[23]王磊,王新,周路纲,等.锁骨钩钢板治疗肩锁关节脱位及锁骨远端骨折术后并发症的探讨[J].创伤外科杂志,2010,12(4):365-365.
[24]顾华,付建,宋小勇,等.锁骨钩钢板治疗锁骨远端骨折与肩锁关节脱位术后肩周疼痛原因分析[J].中国骨与关节损伤杂志,2012,27(7):634-636.
[25]陆军,李永刚,吴小涛,等.肩锁钩钢板内固定对肩关节功能的影响[J].中华损伤与修复杂志(电子版),2013,8(1):26-30.
[26]郭丹,周海斌.锁骨钩钢板治疗RockwoodⅢ型肩锁关节脱位的治疗分析[J].中国矫形外科杂志,2012,20(16):1449-1451.
[27]胡阿威,夏成焱,夏春明,等.锁骨钩钢板与双Endobutton钢板治疗肩锁关节脱位的疗效比较[J].临床骨科杂志,2017,20(1):111-113.
[28]朱义用,汪建良.锁骨钩钢板治疗肩锁关节脱位和锁骨远端骨折的肩痛原因分析[J].中华创伤骨科杂志,2007,9(7):692-693.
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