手术与非手术治疗Ⅲ型肩锁关节脱位的荟萃分析  

Surgical versus non-surgical treatment of type Ⅲ acromioclavicular dislocation:A meta-analysis

作　　者：王磊[1] 张杰[1] 王凤凤[2] 武政[1] WANG Lei;ZHANG Jie;WANG Feng-feng;WU Zheng(Department of Joint Surgery,The Affiliated Hospital,Yanan University,Yanan716000,China;Department of Hematology and Immunology,The Affiliated Hospital,Yanan University,Yanan716000,China)

机构地区：[1]延安大学附属医院关节外科,陕西延安716000 [2]延安大学附属医院血液免疫科,陕西延安716000

出　　处：《中国矫形外科杂志》2024年第4期339-344,共6页Orthopedic Journal of China

基　　金：榆林市产学研项目(编号:CXY-2021-124)。

摘　　要：[目的]系统评价手术与非手术治疗Rockwood Ⅲ型肩锁关节脱位的临床疗效。[方法]检索建库至2022年6月Cochrane Library、PubMed、Web of science、EMBASE、中国知网数据库、万方数据库及中国生物医学数据库,收集比较手术与非手术治疗Rockwood Ⅲ型肩锁关节脱位的临床研究。采用RevMan 5.2软件进行荟萃分析。[结果]共纳入17篇文献,1006例患者。荟萃分析结果显示:手术组肩锁关节炎发生率(OR=6.01,95%CI 2.16~16.68,P=0.0006)、感染发生率(OR=5.92,95%CI1.35~22.91,P=0.02)、异位骨化发生率(OR=1.98,95%CI 1.18~3.32,P=0.009)均显著高于保守组。保守组结局功能优良率(OR=1.75,95%CI 1.19~2.58,P<0.05)、Constant评分显著优于手术组(WMD=1.79,95%CI 1.14~2.43,P<0.05)。保守组和手术组并发症发生率(OR=1.73,95%CI 0.65~4.63,P=0.27)、肩关节疼痛(OR=1.23,95%CI 0.61~2.47,P=0.57)、锁骨外侧骨溶解发生率(OR=1.31,95%CI 0.39~4.38,P=0.66)的差异均无统计学意义。[结论]在并发症、疼痛、肩锁关节溶骨等方面手术和保守治疗没有差别,但是在感染、肩锁关节炎、异位骨化、结局功能优良率、Constant评分等方面,保守治疗有明显优势。[Objective]To systematically evaluate the clinical efficacy of surgical versus non-surgical treatment of Rockwood type Ⅲ acromioclavicular dislocation.[Methods]The literatures regarding comparison of surgical versus non-surgical treatment of Rockwood type Ⅲ acromioclavicular dislocation were searched from the databases,including Cochrane Library,PubMed,Web of science,EMBASE,CNKI database,Wanfang database and China Biomedical Database until June 2022,and then a meta-analysis was performed using RevMan 5.2 software.[Results]A total of 17 articles involving 1006 patients were included.As results of meta-analysis,the surgical group was significantly greater than the non-surgical group in terms of incidence of acromioclavicular arthritis(OR=6.01,95%CI 2.16~16.68,P=0.0006),infection(OR=5.92,95%CI 1.35~22.91,P=0.02)and ectopic ossification(OR=1.98,95%CI 1.18~3.32,P=0.009),while the non-surgical group was significantly better than the surgical group in terms of functional excellence rate(OR=1.75,95%CI 1.19~2.58)and Constant score(WMD=1.79,95%CI 1.14~2.43,P<0.05).However,there was no significant difference between the two groups in terms of incidence of complications(OR=1.73,95%CI 0.65~4.63,P=0.27),shoulder pain(OR=1.23,95%CI 0.61~2.47,P=0.57)and lateral clavicular osteolysis(OR=1.31,95%CI 0.39~4.38,P=0.66).[Conclusion]There is no difference between surgical treatment and non-surgical treatment in terms of complications,pain and osteolysis of acromioclavicular joint,but non-surgical treatment has obvious advantages over the surgical treatment in terms of infection,acromioclavicular arthritis,ectopic ossification,outcome function and constant score.

关 键 词：RockwoodⅢ型肩锁关节脱位 手术治疗 非手术治疗 荟萃分析 

分 类 号：R684.7[医药卫生—骨科学]