Meta-analysis of excellent and good rate and complication of Endobutton plate versus clavicular hook plate for treating acromioclavicular joint dislocation

doi:10.3969/j.issn.2095-4344.0050

Abstract

Abstract:

BACKGROUND: At present, there are many ways to treat acromioclavicular joint dislocation, mainly based on clavicular hook plate, but the anatomical reconstruction of the trapezoid ligament and conoid ligament of the acromioclavicular ligament is the most important trend in the treatment of acromioclavicular joint dislocation. Endobutton plate has been widely promoted in recent years. A large number of randomized controlled trials and retrospective study showed that it has better efficacy and lower incidence of complications compared with the clavicular hook plate.

OBJECTIVE: To evaluate the excellent and good rate and the short-term incidence of complication between Endobutton plate and clavicular hook plate in the treatment of acromioclavicular joint dislocation.

METHODS: The Cochrane Library (1966-06/2017-05), PubMed (1966-06/2017-05), MEDLINE (1966-02/2017-05), EMbase (1984-01/2017-05), CNKI (1979-01/2017-05), VIP (1989-01/2017-05), and Wanfang (1982-01/2017-05) databases were searched by computer. Simultaneously, six major Chinese orthopedic journals were retrieved by hand, and the references included in the related articles were consulted. Randomized controlled trials addressing Endobutton plates and clavicular hook plates for the treatment of acromioclavicular joint dislocation were collected. The literatures were screened for inclusion criteria, and their qualities were evaluated. Meta-analysis was performed using RevMan 5.3 software.

RESULTS AND CONCLUSION: (1) A total of 13 randomized controlled trials containing 800 patients were included in the study. 394 patients were treated with Endobutton plate and 406 patients with clavicular hook plate as controls. Among which, only one study was compared in three different ways; the rest were compared between Endobutton plate and clavicular hook plate. (2) Meta-analysis showed that the excellent and good rate of Endobutton plate was superior to that of clavicular hook plate in the treatment of acromioclavicular joint dislocation (P < 0.000 01). Compared with clavicular hook plate, the incidence of incision infection, acromioclavicular joint pain, limited activity and redislocation were lower in Endobutton plate (P=0.02, < 0.001, < 0.00001, 0.03). (3) These findings suggested that the effect of Endobutton plate was better than that of clavicular hook plate in the treatment of acromioclavicular joint dislocation. The incidences of incision infection, acromioclavicular joint pain, limited mobility, and redislocation were lower in Endobutton plate than in the clavicular hook plate. Although the article included many randomized controlled trials, the qualities of these articles are limited. We still need to design more strictly large-sample randomized controlled trials to increase the credibility of the evidence.

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

Key words: Acromioclavicular Joint, Internal Fixator, Randomized Controlled Trial, Evidence-Based Medicine, Meta-Analysis, Tissue Engineering

CLC Number:

R318

Song Xin, Maimaitishawutiaji•Maimaiti, Yilihamu•Tuoheti, Maihemuti•Yakufu, Chen Hong-tao, Abudusalamu•Abudukelimu, Luo Xiao-ying. Meta-analysis of excellent and good rate and complication of Endobutton plate versus clavicular hook plate for treating acromioclavicular joint dislocation[J]. Chinese Journal of Tissue Engineering Research, 2018, 22(3): 478-485.

Figures/Tables 3

2.5 优良率分析纳入的11个随机对照试验比较了该两种方式术后的优良率[10，11，13-15，17-22]，结果均按Karlsson评定标准。Endobutton钢板组292例，锁骨钩钢板组304例，异质性分析显示，各研究无明显异质性[Chi2=1.33，df=10(P=1.000)，I2=0%]，故采用固定效应模型分析，OR=5.22，95%CI(2.99，9.11)，P < 0.000 01，结果显示2种内固定方式优良率差异有显著性意义(图2)。 2.6 术后切口感染率分析 8个随机对照试验报道固定后伤口感染情况[10-12，14，16-19]，共523例。其中Endobutton钢板组257例，锁骨钩钢板组266例。异质性分析显示，各研究的感染率指标间无明显异质性[Chi2=0.09，df=4(P=1.00)，I2=0%]，故采用固定效应模型分析，OR=0.31，95% CI(0.12，0.85)，P=0.02，结果显示Endobutton 钢板治疗肩锁关节脱位后切口感染与锁骨钩钢板比较差异有显著性意义(图3)。 2.7 肩关节疼痛发生率分析共5个随机对照试验报道了术后肩关节疼痛的发生情况[10，15，17-19]，共239例，其中Endobutton钢板组115例，锁骨钩钢板组124例，异质性分析显示，各研究的疼痛发生率指标间无明显异质性[Chi2=2.40，df=4(P=0.66)，I2=0%]，故采用固定效应模型分析，OR=0.19，95%CI(0.08，0.42)，P < 0.000 1，结果显示Endobutton钢板治疗肩锁关节脱位后肩关节疼痛与锁骨钩钢板比较差异有显著性意义(图4)。 2.8 活动受限发生率分析 5个随机对照试验报道活动受限情况[10，13，16-17，19]，共277例。其中Endobutton钢板组134例，锁骨钩钢板组143例。异质性分析显示，各研究的活动受限发生率指标间无明显异质性[Chi2=0.53，df=3(P=0.91)，I2=0%]，故采用固定效应模型分析，OR=0.16，95%CI(0.07，0.34)，P < 0.000 01，结果显示Endobutton钢板治疗肩锁关节脱位后肩关节活动受限与锁骨钩钢板组比较差异有显著性意义(图5)。 2.9 术后再脱位发生率分析 7个随机对照试验报道手术后再脱位情况[10，12-14，17-19]，共453例。其中Endobutton钢板组224例，锁骨钩钢板组229例。异质性分析显示，各研究的再脱位发生率指标间无明显异质性[Chi2=0.25，df=3(P=0.97)，I2=0%]，故采用固定效应模型分析，OR=0.24，95%CI(0.07，0.85)，P=0.03，结果显示Endobutton钢板治疗肩锁关节脱位后再脱位与锁骨钩钢板术比较差异有显著性意义(图6)。 "

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