三度肩锁关节脱位手术与非手术治疗的系统评价

Systematic review of conservative or surgical treatment of acromioclavicular dislocation

目的:系统评价手术与非手术治疗三度肩锁关节脱位的疗效。方法:检索Cochrane图书馆、Cochrane协作网肌骨专业试验数据库、MEDLINE、EMbase、中国生物医学文献数据库,手检相关中文文献,纳入所有肩锁关节脱位手术与非手术治疗的随机对照试验(Randomised controlled trial,RCT),对其进行质量评价和结果分析。结果:共纳入2篇RCT包括144例患者[1,2],1篇可能存在选择偏倚和测量偏倚,另1篇可能存在轻度偏倚。Meta分析结果显示,手术与非手术治疗在肢体功能恢复方面均取得较满意结果并且没有明显区别。但在返回工作与参加体育活动方面非手术治疗要优于手术治疗。两篇RCT均汇报了相关并发症。结论:非手术治疗与手术治疗肩锁关节脱位在肢体功能恢复上没有区别,但非手术治疗的病人需要更短的时间康复,能更早的返回工作与生活。我们尚需更多设计严格的研究以增加证据的强度。

Objective：To assess the conservative or surgical treatments of acromioclavicular dislocation.Methods：RCTs were identified from specialized trials registered in Cochrane muscle bone group,the Cochrane library,additional electronic search（including MEDLINE,EMBASE and CBM）,and hand-searched for corresponding Chinese Journals.Data were extracted and evaluated.Results：Two published trials including a total of 144 patients met the inclusion criteria for the review,among which one trial had selection and measurement bias,while another,maybe,had slight bias.The mate analysis demonstrates that non-operative managements are better than operative managements according to return subjects to normal walking and take part in athletic sports,and that there have no different between the two methods according to rehabilitation of the physical function.Complications also have been reported in it.Conclusion：Conservative and surgical treatments being used to treat acromioclavicular dislocation,there are no significant differences according to rehabilitation of physical function,but the shorter recovery time and early return to work can be achieved with conservative managements.More trials with high quality on methodology are needed.