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[1]張志猛,袁道通,王旭,等.3種手術(shù)方法治療RockwoodⅢ型及以上肩鎖關(guān)節(jié)脫位臨床療效的網(wǎng)狀Meta分析[J].中醫(yī)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種手術(shù)方法治療RockwoodⅢ型及以上肩鎖關(guān)節(jié)脫位臨床療效的網(wǎng)狀Meta分析()
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《中醫(yī)正骨》[ISSN:1001-6015/CN:41-1162/R]

卷:
第36卷
期數(shù):
2024年10期
頁碼:
25-31,56
欄目:
文獻研究
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:
張志猛1; 袁道通1; 王旭2; 謝文鵬3; 張永奎3
1.山東中醫(yī)藥大學第一臨床醫(yī)學院,山東 濟南 250014; 2.濟南市中醫(yī)醫(yī)院,山東 濟南 250012; 3.山東中醫(yī)藥大學附屬醫(yī)院,山東 濟南 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
關(guān)鍵詞:
肩鎖關(guān)節(jié);  脫位;  骨折固定術(shù); 內(nèi);  韌帶重建;  網(wǎng)絡(luò)Meta分析
Keywords:
acromioclavicular joint;  dislocations;  fracture fixation; internal;  ligament reconstruction;  network Meta-analysis
摘要:
目的:系統(tǒng)評價鉤鋼板內(nèi)固定、帶袢鋼板內(nèi)固定和韌帶重建術(shù)這3種手術(shù)方法治療肩鎖關(guān)節(jié)脫位的臨床療效。方法:應用計算機檢索中國知網(wǎng)、維普網(wǎng)、萬方數(shù)據(jù)庫、中國生物醫(yī)學文獻服務(wù)系統(tǒng)、PubMed、Embase和Cochrane Library中關(guān)于手術(shù)方法治療RockwoodⅢ型及以上肩鎖關(guān)節(jié)脫位的對比研究文獻,檢索時限均為建庫至2024年1月1日。試驗組采用鉤鋼板內(nèi)固定、帶袢鋼板內(nèi)固定或韌帶重建術(shù),對照組采用與試驗組不同的上述3種手術(shù)方法中的1種。依據(jù)文獻檢索及篩選方案篩選出符合要求的文獻后,由2名研究人員分別獨立進行數(shù)據(jù)提取和質(zhì)量評價。采用Stata14.0軟件對手術(shù)時間、住院時間、術(shù)后3個月Constant-Murley肩關(guān)節(jié)評分、術(shù)后1年Constant-Murley肩關(guān)節(jié)評分、術(shù)后再次脫位發(fā)生率進行網(wǎng)狀Meta分析,并根據(jù)累計概率排名曲線下面積(the surface under the cumulative ranking curve,SUCRA)進行排序。采用漏斗圖檢驗發(fā)表偏倚。結(jié)果:共檢索到1371篇文獻,最終納入17篇文獻。手術(shù)時間排序為韌帶重建術(shù)(SUCRA=89.5%)>帶袢鋼板內(nèi)固定(SUCRA=59.6%)>鉤鋼板內(nèi)固定(SUCRA=0.9%); 住院時間排序為鉤鋼板內(nèi)固定(SUCRA=94.8%)>帶袢鋼板內(nèi)固定(SUCRA=49.6%)>韌帶重建術(shù)(SUCRA=5.6%); 術(shù)后3個月Constant-Murley肩關(guān)節(jié)評分排序為韌帶重建術(shù)(SUCRA=99.3%)>帶袢鋼板內(nèi)固定(SUCRA=50.6%)>鉤鋼板內(nèi)固定(SUCRA=0.1%); 術(shù)后1年Constant-Murley肩關(guān)節(jié)評分排序為韌帶重建術(shù)(SUCRA=79.3%)>帶袢鋼板內(nèi)固定(SUCRA=69.2%)>鉤鋼板內(nèi)固定(SUCRA=1.5%); 術(shù)后再次脫位發(fā)生率排序為韌帶重建術(shù)(SUCRA=97.5%)>鉤鋼板內(nèi)固定(SUCRA=45.9%)>帶袢鋼板內(nèi)固定(SUCRA=6.6%)。結(jié)論:現(xiàn)有證據(jù)表明,采用手術(shù)方法治療RockwoodⅢ型及以上肩鎖關(guān)節(jié)脫位,鉤鋼板內(nèi)固定在縮短手術(shù)時間方面更具優(yōu)勢,韌帶重建術(shù)在縮短住院時間、緩解疼痛及恢復肩關(guān)節(jié)功能等方面更具優(yōu)勢,帶袢鋼板內(nèi)固定在預防術(shù)后再次脫位發(fā)生方面更具優(yōu)勢。
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.

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通訊作者:張永奎 E-mail:[email protected]
更新日期/Last Update: 1900-01-01