[1]张志猛,袁道通,王旭,等.3种手术方法治疗RockwoodⅢ型及以上肩锁关节脱位临床疗效的网状Meta分析[J].中医正骨,2024,36(10):25-31,56.
　ZHANG Zhimeng,YUAN Daotong,WANG Xu,et al.Clinical efficacy of three surgical procedures in treatment of Rockwood typeⅢand above acromioclavicular joint dislocation:a network meta-analysis[J].The Journal of Traditional Chinese Orthopedics and Traumatology,2024,36(10):25-31,56.
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3种手术方法治疗RockwoodⅢ型及以上肩锁关节脱位临床疗效的网状Meta分析()
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《中医正骨》[ISSN:1001-6015/CN:41-1162/R]

卷:
第36卷
期数:
2024年10期
页码:
25-31,56
栏目:
文献研究
出版日期:
2024-10-20

文章信息/Info

Title:
Clinical efficacy of three surgical procedures in treatment of Rockwood typeⅢand above acromioclavicular joint dislocation:a network meta-analysis
作者:
张志猛1; 袁道通1; 王旭2; 谢文鹏3; 张永奎3
1.山东中医药大学第一临床医学院,山东 济南 250014; 2.济南市中医医院,山东 济南 250012; 3.山东中医药大学附属医院,山东 济南 250014
Author(s):
ZHANG Zhimeng1; YUAN Daotong1; WANG Xu2; XIE Wenpeng3; ZHANG Yongkui3
1.The First Clinical Medical College of Shandong University of Traditional Chinese Medicine,Jinan 250014,Shandong,China 2.Jinan Municipal Hospital of Traditional Chinese Medicine,Jinan 250012,Shandong,China 3.The Affiliated Hospital of Shandong University of Traditional Chinese Medicine,Jinan 250014,Shandong,China
关键词:
肩锁关节;  脱位;  骨折固定术; 内;  韧带重建;  网络Meta分析
Keywords:
acromioclavicular joint;  dislocations;  fracture fixation; internal;  ligament reconstruction;  network Meta-analysis
摘要:
目的:系统评价钩钢板内固定、带袢钢板内固定和韧带重建术这3种手术方法治疗肩锁关节脱位的临床疗效。方法:应用计算机检索中国知网、维普网、万方数据库、中国生物医学文献服务系统、PubMed、Embase和Cochrane Library中关于手术方法治疗RockwoodⅢ型及以上肩锁关节脱位的对比研究文献,检索时限均为建库至2024年1月1日。试验组采用钩钢板内固定、带袢钢板内固定或韧带重建术,对照组采用与试验组不同的上述3种手术方法中的1种。依据文献检索及筛选方案筛选出符合要求的文献后,由2名研究人员分别独立进行数据提取和质量评价。采用Stata14.0软件对手术时间、住院时间、术后3个月Constant-Murley肩关节评分、术后1年Constant-Murley肩关节评分、术后再次脱位发生率进行网状Meta分析,并根据累计概率排名曲线下面积(the surface under the cumulative ranking curve,SUCRA)进行排序。采用漏斗图检验发表偏倚。结果:共检索到1371篇文献,最终纳入17篇文献。手术时间排序为韧带重建术(SUCRA=89.5%)>带袢钢板内固定(SUCRA=59.6%)>钩钢板内固定(SUCRA=0.9%); 住院时间排序为钩钢板内固定(SUCRA=94.8%)>带袢钢板内固定(SUCRA=49.6%)>韧带重建术(SUCRA=5.6%); 术后3个月Constant-Murley肩关节评分排序为韧带重建术(SUCRA=99.3%)>带袢钢板内固定(SUCRA=50.6%)>钩钢板内固定(SUCRA=0.1%); 术后1年Constant-Murley肩关节评分排序为韧带重建术(SUCRA=79.3%)>带袢钢板内固定(SUCRA=69.2%)>钩钢板内固定(SUCRA=1.5%); 术后再次脱位发生率排序为韧带重建术(SUCRA=97.5%)>钩钢板内固定(SUCRA=45.9%)>带袢钢板内固定(SUCRA=6.6%)。结论:现有证据表明,采用手术方法治疗RockwoodⅢ型及以上肩锁关节脱位,钩钢板内固定在缩短手术时间方面更具优势,韧带重建术在缩短住院时间、缓解疼痛及恢复肩关节功能等方面更具优势,带袢钢板内固定在预防术后再次脱位发生方面更具优势。
Abstract:
Objective:To systematically review the clinical efficacy of hook plate internal fixation,loop plate internal fixation and ligament reconstruction in treatment of acromioclavicular joint dislocation(ACJD).Methods:All the comparative study articles about surgical procedure for treatment of Rockwood typeⅢand above ACJD included from database's inception to January 1,2024 were retrieved from the China National Knowledge Infrastructure,Vip Database,Wanfang Database,Chinese Biomedical Literature Service System,PubMed,Embase,and Cochrane Library through computer.The patients in experiment group were treated with hook plate internal fixation,loop plate internal fixation or ligament reconstruction,while the ones in control group with one of the above three surgical methods differing from the one used in experiment group.The eligible articles were screened according to the retrieval and screening scheme.The information was extracted and the methodological quality of the included researches in the articles was evaluated independently by two researchers,and then a reticulated Meta-analysis on operative time,hospital stays,Constant-Murley shoulder scores measured at 3 and 12 months after the surgery,and postsurgical redislocation incidence rate was conducted by using Stata14.0 software,furthermore,the efficacies of the adopted surgical methods were ranked according to the surface under the cumulative ranking curve(SUCRA),and the publication bias was tested by using funnel plots.Results:One thousand three hundred and seventy-one articles were searched out.After screening,17 articles were included in the final analysis.The results of reticulated Meta-analysis showed that,in treatment of ACJD,the ligament reconstruction(SUCRA=89.5%)behaved best in operative time,followed by loop plate internal fixation(SUCRA=59.6%)and hook plate internal fixation(SUCRA=0.9%); and the hook plate internal fixation(SUCRA=94.8%)behaved best in hospital stays,followed by loop plate internal fixation(SUCRA=49.6%)and ligament reconstruction(SUCRA=5.6%); and the ligament reconstruction(SUCRA=99.3%)behaved best in Constant-Murley shoulder score measured at 3 months after the surgery,followed by loop plate internal fixation(SUCRA=50.6%)and hook plate internal fixation(SUCRA=0.1%); and the ligament reconstruction(SUCRA=79.3%)behaved best in Constant-Murley shoulder score measured at 12 months after the surgery,followed by loop plate internal fixation(SUCRA=69.2%)and hook plate internal fixation(SUCRA=1.5%); and the ligament reconstruction(SUCRA=97.5%)behaved best in postsurgical redislocation incidence rate,followed by hook plate internal fixation(SUCRA=45.9%)and loop plate internal fixation(SUCRA=6.6%).Conclusion:Available evidences suggest that,in treatment of Rockwood typeⅢand above ACJD,the hook plate internal fixation behaves best in shortening operative time,the ligament reconstruction performs best in shortening hospital stays,alleviating pain,and restoring shoulder joint function,while,the loop plate internal fixation acts best in preventing postoperative redislocation.

参考文献/References:

[1] KENNEDY M I,PEEBLES L A,PROVENCHER M T,et al.Acromioclavicular and coracoclavicular ligament reconstruction for acromioclavicular joint instability[J].JBJS Essent Surg Tech,2019,9(4):e32.1-e32.2.
[2] 黄仁邦,郑启渔,曾宪钦,等.小切口可调节带袢钛板固定肩锁脱位[J].中国矫形外科杂志,2023,31(9):843-846.
[3] 刘云鹏,刘沂.骨与关节损伤和疾病的诊断分类及功能评定标准[M].北京:清华大学出版社,2002:16-17.
[4] TAMAOKI M J,LENZA M,MATSUNAGA F T,et al.Surgical versus conservative interventions for treating acromioclavicular dislocation of the shoulder in adults[J].Cochrane Database Syst Rev,2019,10(10):CD007429.
[5] 田朝奇,马国涛,吴登科,等.肩关节镜辅助Tight Rope钢板与常规切开复位内固定治疗肩锁关节脱位的效果对比[J].临床医学工程,2023,30(5):599-600.
[6] 王梦晗,张元,陈言智.肩锁关节脱位的诊疗现状[J].中国当代医药,2022,29(33):32-37.
[7] YIN J,YIN Z,GONG G,et al.Comparison of hook plate with versus without double-tunnel coracoclavicular ligament reconstruction for repair of acute acromioclavicular joint dislocations:a prospective randomized controlled clinical trial[J].Int J Surg,2018,54(Pt A):18-23.
[8] 李晓东,李龙云,程勇杰,等.TightRope带袢钢板与锁骨钩钢板内固定治疗肩锁关节脱位疗效比较的Meta分析[J].中国骨与关节损伤杂志,2023,38(5):471-474.
[9] 李诗怡,许明泽,周雨欣,等.喙锁韧带重建术治疗肩锁关节脱位的研究进展[J].中外医学研究,2024,22(8):174-178.
[10] MUENCH L N,BERTHOLD D P,UYEKI C,et al.Conversion to anatomic coracoclavicular ligament reconstruction(ACCR)shows similar clinical outcomes compared to successful non-operative treatment in chronic primary typeⅢtoⅤacromioclavicular joint injuries[J].Knee Surg Sports Traumatol Arthrosc,2021,29(7):2264-2271.
[11] YANCEY J R,SZCZEPANIK M.Acromioclavicular joint dislocation:surgical vs.conservative interventions[J].Am Fam Physician,2021,104(1):28-29.
[12] 王磊,张杰,王凤凤,等.手术与非手术治疗Ⅲ型肩锁关节脱位的荟萃分析[J].中国矫形外科杂志,2024,32(4):339-344.
[13] SMITH T O,CHESTER R,PEARSE E O,et al.Operative versus non-operative management following Rockwood gradeⅢacromioclavicular separation:a Meta-analysis of the current evidence base[J].J Orthop Traumatol,2011,12(1):19-27.
[14] BHASKARWAR A P,DEV JAIDEV K P,JOSHI R K,et al.Managing acute acromioclavicular joint dislocation during COVID 19 pandemic by minimally invasive technique with suture anchor and miniplate:a pilot study[J].Med J Armed Forces India,2022,79(Suppl 1):S217-S223.
[15] 蒋协远,王大伟.骨科临床疗效评价标准[M].北京:人民卫生出版社,2005:67-68.
[16] CUMPSTON M,LI T,PAGE M J,et al.Updated guidance for trusted systematic reviews:a new edition of the Cochrane Handbook for Systematic Reviews of Interventions[J].Cochrane Database Syst Rev,2019,10(10):ED000142.
[17] CAI L,WANG T,LU D,et al.Comparison of the tight rope technique and clavicular hook plate for the treatment of rockwood typeⅢacromioclavicular joint dislocation[J].J Invest Surg,2018,31(3):226-233.
[18] PONGSAMAKTHAI W,THARAKULPHAN S.Clavicular hook plate versus Tightrope fixation in acromioclavicular joint dislocation:a randomized prospective controlled trial[J].J Med Assoc Thai,2018,101(3):S87-S93.
[19] 蔡史健,钟志刚,赵资坚.带袢纽扣钢板在TossyⅢ型肩锁关节脱位治疗中的应用价值[J].中国当代医药,2017,24(28):111-113.
[20] 陈琼,赵俊强,余冬梅.纽扣钢板与锁骨钩钢板内固定治疗RockwoodⅢ～Ⅴ型肩锁关节脱位的效果比较[J].中国医药导报,2017,14(12):89-92.
[21] 陈益果.带绊纽扣钢板治疗RockwoodⅢ型肩锁关节脱位的临床观察[J].骨科临床与研究杂志,2020,5(6):340-343.
[22] 何伟,江红卫,崔学文,等.带袢钢板与肩锁钩钢板治疗Ⅲ型肩锁关节脱位的临床疗效比较[J].医药前沿,2015,5(24):65-66.
[23] 黄健林,刘文涛.掌长肌腱重建韧带与钩钢板治疗肩锁关节脱位的比较[J].实用骨科杂志,2020,26(5):447-451.
[24] 姜丹生,黄坚.不同手术方式治疗肩锁关节脱位的疗效对比[J].中华全科医学,2018,16(3):404-406.
[25] 刘文涛,黄健林,何晖,等.双带袢钢板技术与取掌长肌腱重建喙锁韧带治疗Ⅲ型肩锁关节脱位的效果对比[J].保健文汇,2021,22(16):185-186.
[26] 鲁驷原,周百刚,周劲松,等.3种不同手术方案治疗RockwoodⅢ型肩锁关节脱位临床疗效比较[J].临床军医杂志,2017,45(9):954-956.
[27] 谭必波,柯有才.改良Weaver-Dunn法和锁骨钩钢板内固定治疗TossyⅢ型肩锁关节脱位的临床疗效[J].医疗装备,2016,29(23):7-8.
[28] 唐寅,郭宗慧.两种方法治疗肩锁关节脱位的疗效比较[J].临床骨科杂志,2022,25(4):523-526.
[29] 肖建生.改良Weaver-Dunn法和锁骨钩钢板内固定治疗TossyⅢ型肩锁关节脱位的临床疗效[J].中国医疗器械信息,2017,23(15):111-112.
[30] 谢亮,张彦祥,高博,等.自体腓骨长肌腱前侧半重建喙锁韧带与钩钢板固定治疗RockwoodⅢ～Ⅴ型肩锁关节脱位疗效观察[J].海南医学,2019,30(20):2654-2657.
[31] 许海云,吴一雄,樊友亮,等.带袢纽扣钢板与锁骨钩钢板治疗肩锁关节脱位的临床疗效对比分析[J].临床和实验医学杂志,2016,15(20):2001-2004.
[32] 张辉,唐毅,赖国超,等.双束带袢钢板原位重建治疗RockwoodⅢ-Ⅳ型肩锁关节脱位的效果[J].局解手术学杂志,2020,29(2):130-134.
[33] 张胜杰,王哲,崔继君.带袢纽扣钢板治疗TossyⅢ型肩锁关节脱位的临床研究[J].湖南师范大学学报(医学版),2017,14(1):159-161.
[34] 熊昌文,赵喆.肩锁关节脱位治疗的研究进展[J].中医正骨,2020,32(6):44-48.
[35] 彭硕,黄菲菲,蒋慧韬,等.肩锁关节脱位的临床诊断及手术治疗进展[J].甘肃医药,2024,43(4):297-311.
[36] 房燚,赵文志,潘德悦,等.肩锁关节脱位研究:如何达到解剖复位和持续性稳定及关节微动[J].中国组织工程研究,2020,24(5):796-802.
[37] 邵梦伟,周一飞,郑钧,等.肩锁关节脱位的生物力学研究及治疗进展[J].内蒙古医科大学学报,2024,46(1):91-95.
[38] ?ZCAFER R,ALBAYRAK K,LAPCIN O,et al.Early clinical and radiographic results of fixation with the TightRope device for Rockwood type V acromioclavicular joint dislocation:a retrospective review of 15 patients[J].Acta Orthop Traumatol Turc,2020,54(5):473-477.
[39] NOLTE P C,LACHETA L,DEKKER T J,et al.Optimal management of acromioclavicular dislocation:current perspectives[J].Orthop Res Rev,2020,12:27-44.
[40] JENSEN G,KATTHAGEN J C,ALVARADO L E,et al.Has the arthroscopically assisted reduction of acute AC joint separations with the double Tight-rope technique advantages over the clavicular hook plate fixation?[J].Knee Surg Sports Traumatol Arthrosc,2014,22(2):422-430.
[41] XU D,LOU W,LI M,et al.The influence of hook tip in different depths on the acromioclavicular joint dislocation treated with clavicular hook plate:a retrospective study[J].Asian J Surg,2021,44(11):1459-1460.
[42] PAN X,LV R Y,LV M G,et al.TightRope vs clavicular hook plate for Rockwood Ⅲ-Ⅴ acromioclavicular dislocations:a Meta-analysis[J].Orthop Surg,2020,12(4):1045-1052.
[43] DE ROOIJ P P,VAN LIESHOUT E M M,SCHURINK I J,et al.Current practice in the management of acromioclavicular joint dislocations; a national survey in the Netherlands[J].Eur J Trauma Emerg Surg,2021,47(5):1417-1427.
[44] QIAO R,YANG J,ZHANG K,et al.To explore the reasonable selection of clavicular hook plate to reduce the occurrence of subacromial impingement syndrome after operation[J].J Orthop Surg Res,2021,16(1):180.
[45] 庞广兴,刘先银,汪宇,等.手术操作因素对NeerⅡ型锁骨远端骨折切开复位锁骨钩钢板内固定术后肩峰骨溶解的影响[J].中国骨与关节损伤杂志,2020,35(11):1140-1142.
[46] 费冀,杨砥,曾靖云,等.锁骨远端骨折锁骨钩钢板内固定术后严重肩关节功能障碍1例[J].中医正骨,2021,33(5):77-79.
[47] 姜晨轶,林森.肩峰形态对锁骨钩钢板固定术后肩峰骨溶解及骨折的影响[J].中华创伤骨科杂志,2019,21(5):405-410.
[48] PATEL M S,HILL B W,CASEY P,et al.Modified Weaver-Dunn technique using transosseous bone tunnels and coracoid suture augmentation[J].J Am Acad Orthop Surg,2022,30(3):111-118.
[49] 陈东旭,李朝旭,王胜涛,等.三种术式治疗RockwoodⅢ型肩锁关节脱位比较[J].中国矫形外科杂志,2023,31(12):1075-1080.
[50] QI J,FU S,PING R,et al.Biomechanical testing of three coracoclavicular ligament reconstruction techniques with a 3D printing navigation template for clavicle-coracoid drilling[J].Ann Transl Med,2021,9(14):1121.
[51] 张宪发,王晶,刘阔沦,等.国内TightRope与锁骨钩钢板治疗肩锁关节脱位疗效比较的Meta分析[J].医学信息,2024,37(4):42-50.

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　WANG Chenlin,LI Dan,SUI Haiming,et al.Clinical study on minimally invasive transforaminal lumbar interbody fusion combined with traditional Chinese medicine packet therapy for treatment of lumbar spondylolisthesis[J].The Journal of Traditional Chinese Orthopedics and Traumatology,2016,28(10):42.
[10]毕 锴.颈椎手法常见高危禁忌证的X线诊断[J].中医正骨,2016,28(08):73.
[11]徐洪伟,康信勇,贺振年,等.带袢钢板内固定治疗急性肩锁关节脱位[J].中医正骨,2015,27(11):48.
[12]孙辽军,卢迪,余贤斌,等.喙突骨隧道位置对双Endobutton钢板重建 术后喙锁韧带力学性能的影响[J].中医正骨,2015,27(05):1.
　SUN Liaojun,LU Di,YU Xianbin,et al.Effect of location of coracoid tunnel on the mechanical property of coracoclavicular ligament after reconstruction using double Endobutton[J].The Journal of Traditional Chinese Orthopedics and Traumatology,2015,27(10):1.
[13]田玉鹏,汤善兵,褚向明,等.关节镜下Endobutton钢板联合指骨钢板内固定治疗 新鲜RockwoodⅢ型肩锁关节脱位[J].中医正骨,2015,27(05):21.
[14]卢启贵,李长树,黄东红,等.关节镜下Endobutton钢板内固定治疗肩锁关节脱位[J].中医正骨,2015,27(05):23.
[15]赵胜春,吴国林.Endobutton钢板内固定治疗急性肩锁关节脱位[J].中医正骨,2018,30(02):72.
[16]熊昌文,赵喆.肩锁关节脱位治疗的研究进展[J].中医正骨,2020,32(06):44.

备注/Memo

备注/Memo:
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更新日期/Last Update: 1900-01-01