中国组织工程研究

中国组织工程研究 ›› 2021, Vol. 25 ›› Issue (3): 463-470.doi: 10.3969/j.issn.2095-4344.2939

• 骨与关节循证医学 evidence-based medicine of the bone and joint • 上一篇    下一篇

双Endobutton与锁骨钩钢板治疗肩锁关节脱位疗效比较的Meta分析

李  洋，张明勇   

  1. 武汉科技大学附属天佑医院骨科，湖北省武汉市   430064
  • 收稿日期:2020-03-09 修回日期:2020-03-14 接受日期:2020-04-18 出版日期:2021-01-28 发布日期:2020-11-19
  • 通讯作者: 张明勇，硕士，硕士生导师，主任医师，湖北省武汉市武汉科技大学附属天佑医院骨科，湖北省武汉市 430064
  • 作者简介:李洋，男，1991年生，湖北省广水市人，汉族，武汉科技大学临床学院在读硕士研究生，医师，主要从事关节骨科、创伤骨科研究。

Meta-analysis of the effect of double Endobutton and clavicular hook plate on the treatment of acromioclavicular dislocation

Li Yang, Zhang Mingyong   

  1. Department of Orthopedics, Tianyou Hospital Affiliated to Wuhan University of Science and Technology, Wuhan 430064, Hubei Province, China
  • Received:2020-03-09 Revised:2020-03-14 Accepted:2020-04-18 Online:2021-01-28 Published:2020-11-19
  • Contact: Zhang Mingyong, Master, Master’s supervisor, Chief physician, Department of Orthopedics, Tianyou Hospital Affiliated to Wuhan University of Science and Technology, Wuhan 430064, Hubei Province, China
  • About author:Li Yang, Master candidate, Physician, Department of Orthopedics, Tianyou Hospital Affiliated to Wuhan University of Science and Technology, Wuhan 430064, Hubei Province, China

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摘要：

文题释义：
双Endobutton(Double Endobutton)钢板：又称带袢钢板或纽扣钢板，在锁骨和喙突之间重新建立了类似喙锁韧带的解剖结构，且其重建装置的刚度和强度要比原始韧带大约40%，能很好地起到内固定作用。同时该手术方式具有手术时间短、出血量少、切口小、术后肩关节功能恢复好及无需二次手术取出内固定装置等优点。
锁骨钩钢板：又称钩钢板，它是一种一侧带有横钩的特殊类型钢板，钩朝向外侧，勾住肩峰，内侧钢板上带有螺钉孔，可以通过螺钉固定在锁骨外侧，把上抬的锁骨外侧下压，是目前是治疗肩锁关节脱位的最主要方式，由于它是一种刚性固定方式，限制了肩关节活动，尤其是外展活动，因此容易出现肩关节疼痛、肩关节活动受限、肩峰撞击综合征、再脱位等并发症。

目的：双Endobutton钢板因比锁骨钩钢板在治疗肩锁关节脱位上更有优势，且创伤小，无需二次通过手术取出内固定物，因此近年来被广泛应用临床。通过Meta分析来探讨双Endobutton钢板与锁骨钩钢板两种手术方式在肩锁关节脱位治疗上有无差异，为临床治疗提供有效指导。
方法：检索Cochrane library、PubMed、EBSCO、中国知网、维普、万方数据库，时间限定为建库至2020年1月，收集所有与双Endobutton 钢板与锁骨钩钢板治疗肩锁关节脱位有关的文献，按纳入与排除标准筛选文献，提取资料并进行有关分析后筛选出符合要求的文献，并进行严密的质量评估，由RevMan 5.3软件对所有结果指标进行分析。 
结果：①共纳入38篇文献，病例数合计为2 199例，其中双Endobutton钢板组1 035例，锁骨钩钢板组1 164例。②结果显示双Endobutton钢板组在术后优良率[RR=1.19，95%CI(1.13，1.26)，P < 0.000 01]、手术时间[MD=10.54，95%CI(6.09，15.00)，P < 0.000 01]、术中出血量[MD= -14.83，95%CI(-20.54，-9.13)，P < 0.000 01]、住院时间[MD=-1.44，95% CI(-2.65，-0.23)，P=0.02]、切口长度[MD=-2.87，95%CI (-3.60，-2.14)，P < 0.000 01]、住院费用[MD=-2 442.10，95%CI(-4 466.34，-417.86)，P=0.02]、术后出现肩关节疼痛[RR=0.34，95%CI(0.22，0.53)，P < 0.000 01]、目测类比评分[MD=-0.85，95%CI(-1.28，-0.41)，P=0.000 2]及术后6个月和末次Constant-Murley 评分[MD=8.82，95%CI(1.91，15.72)，P=0.01；MD=6.66，95%CI(4.46，8.86)，P < 0.000 01]方面均优于锁骨钩钢板组。
结论：与锁骨钩钢板比较，双Endobutton钢板在治疗Rockwood Ⅲ型及以上肩锁关节脱位上，有手术时间短、术中出血少、创伤小、住院时间短及费用少，术后肩关节功能恢复良好等优点。

https://orcid.org/0000-0003-1416-5343(李洋)

中国组织工程研究杂志出版内容重点：人工关节；骨植入物；脊柱；骨折；内固定；数字化骨科；组织工程


关键词: 骨, 关节, 肩锁关节, 脱位, 双Endobutton钢板, 锁骨钩钢板, 钢板, Meta分析

Abstract: OBJECTIVE: Because the double Endobutton plate has more advantages than the clavicle hook plate in the treatment of acromioclavicular joint dislocation, and the trauma is small; it does not need to be removed through secondary surgery. Thus, it has been widely used in clinical practice in recent years. 
Meta-analysis was used to investigate whether there were differences in the treatment of acromioclavicular dislocation between double Endobutton plate and clavicle hook plate so as to provide effective guidance for clinical treatment.
METHODS: The database Cochrane library, PubMed, EBSCO, CNKI, VIP and Wanfang were searched from the database inception to January 2020. All the literatures related to the treatment of acromioclavicular dislocation with double Endobutton plate and clavicle hook plate were collected. The literatures were selected according to the inclusion and exclusion criteria to extract the data and to carry out the relevant analysis. The literatures that meet the requirements were screened out. The quality of the selected relevant literatures was assessed. All outcome indicators were analyzed by RevMan 5.3 software. 
RESULTS: (1) A total of 38 articles were included, and the total number of cases was 2 199, of which 1 035 cases were in the double Endobutton plate group and 1 164 cases were in the clavicle hook plate group. (2) The results showed that the double Endobutton plate group was superior to the clavicle hook plate group in the excellent and good rate [RR=1.19, 95%CI(1.13, 1.26), P < 0.000 01], operation time [MD=10.54, 95% CI(6.09, 15.00), P < 0.000 01], intraoperative blood loss [MD=-14.83, 95%CI(-20.54,-9.13), P < 0.000 01], hospitalization time [MD=-1.44, 95%CI(-2.65,-0.23), P=0.02], incision length [MD=-2.87, 95%CI (-3.60, -2.14), P < 0.000 01], hospitalization cost [MD=-2 442.10, 95% CI(-4 466.34, -417.86), P=0.02], shoulder pain after operation [RR=0.34, 95%CI(0.22, 0.53), P < 0.000 01], visual analogue scale score [MD=-0.85, 95% CI(-1.28, -0.41), P=0.000 2], final Constant-Murley score at 6 months postoperatively [MD=8.82, 95%CI(1.91, 15.72), P=0.01; MD=6.66, 95%CI(4.46, 8.86), P < 0.000 01]. 
CONCLUSION: The treatment of Rockwood III type and above acromioclavicular joint dislocation with double Endobutton plate is superior to that clavicular hook plate. It has the advantages of short operation time, less intraoperative blood loss, less trauma, short hospitalization time and less cost, and good functional recovery of shoulder joint after operation.

Key words: bone, joint, acromioclavicular joint, dislocation, double Endobutton plate, clavicular hook plate, steel plate, meta-analysis

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