肩锁与喙锁关节植入物内固定治疗肩锁关节脱位疗效比较的Meta分析

Curative effects of acromioclavicular fixation versus coracoclavicular fixation for acromioclavicular joint dislocations through Meta-analysis

背景:有关肩锁关节脱位治疗的报道很多,虽然采用的手术方式和固定材料存在差异,但总体而言可分为两大类,即肩锁固定和喙锁固定。究竟何种方式疗效更佳,目前还存在很大的争议。目的:应用Meta分析的方法对比肩锁固定和喙锁固定治疗肩锁关节脱位的疗效。方法:计算机检索Pubmed(1950年1月至2011年10月)、EMBASE(1966年1月至2011年10月)、维普中文科技期刊数据库(1989年1月至2011年10月)、万方数据库(1982年1月至2011年10月)及中国知网数据库(1979年1月至2011年10月)中有关比较肩锁固定和喙锁固定治疗肩锁关节脱位的随机对照试验,按照文中所述纳入标准搜集后进行对比,利用RevMan5.0软件进行异质性分析及Meta分析,绘制森林图。结果与结论:共9篇文章(473例患者,473侧肩锁关节)符合纳入标准。Meta分析结果显示,肩锁固定与喙锁固定治疗肩锁关节脱位的固定后肩关节功能评分差异无显著性意义,两者在固定后上肢肌力、肩关节活动度、固定后再次脱位率等指标变化上差异亦无显著性意义。因此临床上肩锁关节脱位的治疗不强求采用肩锁固定或是喙锁固定,可根据患者病情、所在医院的条件及术者对不同手术方法的熟悉程度等条件来选择合适的固定方式。

BACKGROUND：A lot of reports focus on the treatment of acromioclavicular joint dislocations with many differences on the methods and implants.The methods for treatment of the acromioclavicular joint dislocations which used more often in clinic are acromioclavicular fixation and coracoclavicular fixation.There exists great controversy on which method is better.OBJECTIVE：To compare the curative effects between acromioclavicular fixation and coracoclavicular fixation for acromioclavicular joint dislocations through Meta-analysis.METHODS：Related randomized controlled trials on acromioclavicular fixation and coracoclavicular fixation for acromioclavicular joint dislocations were searched in PubMed database（1950-01/2011-10）,EMBASE database（1966-01/2011-10）,CNKI database（1979-01/2011-10）,Wanfang database（1982-01/2011-10） and VIP database（1989-01/2011-10）.The articles were collected according to the inclusion criteria and then compared.Heterogeneity analysis and Meta-analysis were performed using RevMan5.0 software,and then the forest graph was made.RESULTS AND CONCLUSION：Nine articles involving 473 patients and 473 acromioclavicular joints were accepted in our Meta-analysis.There were no significant differences in curative effect score,strength of upper limbs,shoulder movement,re-dislocations rate between acromioclavicular fixation and coracoclavicular fixation.Therefore,the clinical treatment of acromioclavicular joint dislocation can not only use the acromioclavicular fixed or coracoclavicular fixation,doctors should choose the best method according to the patients＇ condition,hospital conditions and the surgery proficiency of the doctor.