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

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 Co- chrane 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，1 006 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%CI 1.35~22.91, 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。

Abstract:

[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 1 006 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 nonsurgical 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.