三种手术方式治疗肩锁关节脱位疗效的网状Meta分析  

Comparison of three surgical procedures in the treatment of acromioclavicular dislocation:a network meta-analysis

作　　者：王利航 孙官文 包呼和 倪熙宇 张万印 黄斐 杨鹏波 Wang Lihang;Sun Guanwen;Bao Huhe;Ni Xiyu;Zhang Wanyin;Huang Fei;Yang Pengbo(Baotou Medical College,Inner Mongolia University of Science&Technology,Baotou 014040,China;Department of Orthopedics,People's Hospital of Inner Mongolia,Hohhot 010020,China)

机构地区：[1]内蒙古科技大学包头医学院,014040 [2]内蒙古自治区人民医院骨科中心,呼和浩特010020

出　　处：《中华肩肘外科电子杂志》2024年第4期332-343,共12页Chinese Journal of Shoulder and Elbow(Electronic Edition)

摘　　要：目的评估不同方式治疗肩锁关节脱位的疗效,并探讨在Double-Endobutton钢板治疗肩锁关节脱位中修复肩锁韧带的必要性。方法检索PubMed、Embase、Cochrane Library、CNKI、WF、VIP、Sinomed等,检索国内外公开发表的中、英文文献,按纳入及排除标准筛选文献,检索年限为建库至2024年5月15日。采用RevMan 5.3和Stata 16软件进行网状Meta分析。结果最终纳入23篇文献,其中随机对照试验11篇、病例对照研究12篇,共纳入1496例患者。网状Meta分析结果表明:与锁骨钩钢板(clavicular hook plate,CHP)术相比,Double-Endobutton及Double-Endobutton联合肩锁韧带修复均能降低术后并发症发生率,增强术后肩关节功能,改善术后疼痛,且差异具有统计学意义。累计概率排序结果显示:(1)手术时间:CHP>Double-Endobutton>Double-Endobutton联合肩锁韧带修复;(2)术中出血量:Double-Endobutton>CHP>Double-Endobutton联合肩锁韧带修复;(3)术后并发症发生率、肩关节Constant-Murley评分(Constant shoulder score,CM)及术后Karlsson评分优良率:Double-Endobutton联合肩锁韧带修复>Double-Endobutton>CHP;(4)视觉模拟评分:Double-Endobutton>Double-Endobutton联合肩锁韧带修复>CHP。结论总体来说,Double-Endobutton及Double-Endobutton联合肩锁韧带修复两种术式在降低术后并发症,增强术后肩关节功能,改善术后疼痛方面优于CHP术;Double-Endobutton联合肩锁韧带修复相较于Double-Endobutton降低术后并发症发生率的效果更佳,其余结局指标相比效果相当,今后仍需更多关于Double-Endobutton联合肩锁韧带修复的高质量、大样本、多中心的随机对照试验进一步证实。Background Acromioclavicular dislocation is a common shoulder injury in orthopedics.The surgical treatment of acromioclavicular dislocation is varied and controversial.In past clinical practice,rigid fixation schemes,such as clavicular hook plate surgery,were mainly used,but with the deepening of people's understanding of acromioclavicular joints,elastic fixation schemes have gradually been recognized by people.A double-Endobutton plate in an elastic fixation scheme has become the primary surgical method for treating acromioclavicular dislocation.However,some scholars believe that double-Endobutton plate surgery only focuses on the reconstruction of the coracoclavicular ligament,ignoring the repair of the acromioclavicular ligament,resulting in an increase in the incidence of postoperative complications such as shoulder instability.Therefore,exploring the excellent clinical effect of different surgical methods in treating acromioclavicular dislocation has become one of the current research hotspots.Objective To evaluate the efficacy of different methods in treating acromioclavicular dislocation and to discuss the necessity of repairing the acromioclavicular ligament in treating acromioclavicular dislocation with the double-Endobutton plate.Methods PubMed,Embase,Cochrane Library,CNKI,WF,VIP,and Sinomed were searched for published Chinese and English literature at home and abroad,and the literature was screened according to inclusion and exclusion criteria.The retrieval period was from May 15,2024.The mesh metaanalysis was performed using RevMan 5.3 and Stata 16 software.Results A total of 24 pieces of literature were included,including 11 randomized controlled trials and 13 case-control studies involving 1496 patients.The results of mesh meta-analysis showed that compared with CHP,both double-Endobutton and double-Endobutton combined with acromioclavicular ligament repair could reduce the incidence of postoperative complications,enhance postoperative shoulder joint function,and improve postoperative pain,and

关 键 词：肩锁关节脱位 肩锁韧带 Double-Endobutton 锁骨钩钢板 网状Meta分析 

分 类 号：R68[医药卫生—骨科学]