自体或同种异体肌腱重建喙锁韧带与锁骨钩钢板治疗肩锁关节脱位效果的Meta分析  

Meta-analysis of coracoclavicular ligament reconstruction with autologous or allogeneic tendon and clavicular hook plate in the treatment of acromioclavicular joint dislocation

作　　者：杨琨 费晨 王鹏飞[2] 张斌飞[2] 杨娜[2] 田丁 庄岩[2] 张堃[2] Yang Kun;Fei Chen;Wang Pengfei;Zhang Binfei;Yang Na;Tian Ding;Zhuang Yan;Zhang Kun(Graduate School of Xi’an Medical University,Xi’an 710068,Shaanxi Province,China;Department of Orthopedic Trauma,Xi’an Honghui Hospital Affiliated to Xi’an Jiaotong University,Xi’an 710054,Shaanxi Province,China)

机构地区：[1]西安医学院研究生学院,陕西省西安市710068 [2]西安交通大学附属西安市红会医院创伤骨科,陕西省西安市710054

出　　处：《中国组织工程研究》2021年第28期4580-4586,共7页Chinese Journal of Tissue Engineering Research

基　　金：陕西省自然科学基金(2017ZDXM-SF-009),项目负责人:张堃。

摘　　要：目的:目前肌腱重建喙锁韧带还处于起始阶段,各研究中同时纳入肌腱重建喙锁韧带与锁骨钩钢板比较的病例数较少,对于此两种治疗方案的临床效果比较还不确定。文章比较自体或同种异体肌腱重建喙锁韧带与锁骨钩钢板治疗肩锁关节脱位的疗效。方法:使用计算机检索PubMed、Embase、Cochrane Library、中国知网、万方、维普数据库,检索时间均从建库到2020年7月。检索国内外关于对比研究自体或同种异体肌腱重建喙锁韧带与锁骨钩钢板治疗肩锁关节脱位疗效的文献。2名研究员根据纳入和排除标准分别独立筛选文献,提取数据,评估文献中的偏倚风险。纳入相关文献使用RevMan 5.3软件将手术时间、术中出血量、住院时间、功能评分、并发症等指标进行Meta分析。据治疗方式分为自体或同种异体肌腱重建喙锁韧带组和锁骨钩钢板组。结果:最终8篇符合纳入标准,包括3项随机对照研究和5项回顾性队列研究,此8篇文章皆为高质量文章,共382例患者,其中自体或同种异体肌腱重建喙锁韧带组共189例,锁骨钩钢板组共193例,术后随访时间最长约为2.5年,最短约为6个月。根据Meta分析表明,重建喙锁韧带组在术后Constant-Murley评分(MD=3.44,95%CI:2.23-4.66)、有效率(OR=9.92,95%CI:2.74-35.84)、术后总并发症(OR=0.11,95%CI:0.04-0.32)均明显优于单纯锁骨钩钢板组(P<0.05),但两组的手术时间(MD=-2.01,95%CI:-15.96-11.95)、术中出血量(MD=-7.37,95%CI:-20.00-5.27)、住院天数(MD=-1.54,95%CI:-4.22-1.13)和目测类比评分(MD=0.10,95%CI:-0.02-0.23)差异无显著性意义(P>0.05)。结论:根据有限的文献证据比较显示,在短期随访中使用自体或同种异体肌腱重建喙锁韧带治疗肩锁关节脱位修复效果优于锁骨钩钢板组,提高了治疗肩锁关节脱位的成功率,并且减少了术后并发症的发生,更有利于促进肩锁关节功能恢复。OBJECTIVE:At present,tendon reconstruction of coracoclavicular ligament is still in the initial stage.In each study,the number of cases involving tendon reconstruction of coracoclavicular ligament versus clavicular hook plate is less.For this,the clinical effect comparison of the two treatment schemes is still uncertain.This paper compared the efficacy of coracoclavicular ligament reconstruction with autologous or allogeneic tendon and clavicular hook plate in the treatment of acromioclavicular joint dislocation.METHODS:A computer was used to retrieve the PubMed,Embase,Cochrane Library,CNKI,Wanfang,and Weipu database.The retrieval time was from the inception of the database to July 2020.Domestic and foreign literature on comparative study of coracoclavicular ligament reconstruction with autologous or allogeneic tendon and clavicular hook plate in the treatment of acromioclavicular joint dislocation was retrieved.Two researchers independently screened the literature according to the inclusion and exclusion criteria,extracted data,and evaluated the risk of bias in the literature.The operation time,intraoperative blood loss,hospital stay,function score,and complications were meta-analyzed with RevMan 5.3 software.According to the treatment,the patients were divided into two groups:autogenous or allogeneic tendon reconstruction coracoclavicular ligament group and clavicular hook plate group.RESULTS:Finally,eight articles met the inclusion criteria,including three randomized controlled studies,five retrospective cohort studies and eight articles with high quality,with 382 patients.There were 189 cases of autogenous or allogeneic tendon reconstruction coracoclavicular ligament group and 193 cases of clavicular hook plate group.The longest postoperative follow-up period was about 2.5 years and the shortest was about 6 months.Meta-analysis showed that postoperative Constant-Murley score(MD=3.44,95%CI:2.23-4.66),effective rate(OR=9.92,95%CI:2.74-35.84),and total postoperative complications(OR=0.11,95%CI:0.04-0.32)were sig

关 键 词：骨 关节 肩 韧带 锁骨 肌腱 脱位 META分析 

分 类 号：R459.9[医药卫生—治疗学] R363[医药卫生—临床医学]