Clavicular hook plate and other surgical methods for type III acromioclavicular joint dislocation: a systematic evaluation

doi:10.3969/j.issn.2095-4344.2014.13.023

Abstract

Abstract:

BACKGROUND: The most common method for acromioclavicular joint dislocation is hook plate fixation. The randomized studies about different surgical treatments of type III acromioclavicular joint dislocation are seldom. Most of them are retrospective case analysis, and systematic evaluation is missing.
OBJECTIVE: To systematically evaluate clinical outcomes and safety between different surgical methods for type III acromioclavicular joint dislocation.
METHODS: Cochrane central register of controlled trials (No. 2 in 2013), PubMed (1966-01/2013-08), Medline (1966-01/2013-08), EMbase (1984-01/2013-08), CNKI (1979-01/2013-08) and VIP (1989-01/2013-08) were searched by computer. Six kinds of Chinese magazines about orthopedics were searched by hand. References of relevant literatures were searched. Randomized controlled trials that were related to different surgical methods for the treatment of type III acromioclavicular joint dislocation were collected. In accordance with inclusion criteria, some literatures were included. Their qualities were assessed strictly. Meta-analysis was performed with RevMan 5.2 software from the Cochrane collaboration.
RESULTS AND CONCLUSION: 108 potentially relevant papers and 7 published studies with randomized controlled trials met all the inclusion criteria. A total of 381 patients were included, containing 193 cases of clavicle hook plate fixation, 115 cases of double Kirschner’s tension band wires fixation, 9 cases of screw fixation, 35 cases of endobutton plates, and 29 cases of internal fixation. One research addressed treatment with three ways, and the remaining were about two ways. Meta-analysis showed that the excellent rate was better in clavicle hook plate fixation than in double Kirschner’s tension band wires fixation for acromioclavicular joint dislocation (P=0.005), but poorer than endobutton plates (P=0.04), and no significant difference was detected as compared with screw fixation and internal fixation (P=0.82, P=1.00). As compared with other therapeutic manners, there were significant differences in shoulder joint pain, fixator ineffectiveness, redislocation, operation time and medical cost (P=0.05, P=0.04, P=0.02, P < 0.000 01, P=0.000 6), but no significant difference was detected in complications and bleeding amount (P=0.71, P=0.35). Results indicated that compared with other fixation manners, the efficiency of clavicle hook plate fixation for acromioclavicular joint dislocation was better than double Kirschner’s tension band wires fixation, but poorer than endobutton plates, which caused shoulder pain and shoulder joint movement disturbance. Fixator ineffectiveness or redislocation seldom occurred. Operation time was short and medical expenses were low. There was no significant difference in complications and bleeding amount. Because the number of cases in this study is few, we should design more strictly large-sample randomized controlled studies to increase the strength 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

全文链接：

Key words: acromioclavicular joint, internal fixators, prostheses and implants, randomized controlled trial, meta-analysis

CLC Number:

R318

Zhang Xiao-yun, Chen Yue-ping, Dong Pan-feng, Kang Jie, Rao Yi, Yuan Zhen-zhong. Clavicular hook plate and other surgical methods for type III acromioclavicular joint dislocation: a systematic evaluation[J]. Chinese Journal of Tissue Engineering Research, 2014, 18(13): 2104-2112.

Figures/Tables 5

2.2 纳入研究的设计纳入的7个研究均为随机对照试验，研究地点均在中国。 2.3 纳入研究对象及一般情况 7个研究共纳入381例患者，其中锁骨钩钢板治疗组总共193例，克氏针张力带固定115例，喙锁螺钉固定9例，纽扣钢板35例，惰性线29例，其中只有1个研究是3种不同方式比较，余均为两种治疗方式相比较。各纳入研究的基本情况见表1。 2.4 纳入研究的方法学评估按照Cochrane系统评价手册5.1.0版推荐的偏倚风险评估标准评价纳入研究的质量，7个随机对照试验均有发生偏倚的可能性[24-30]，见表2。 2.5 优良率Meta分析结果锁骨钩与克氏针张力带：4个随机对照试验报道了这两种方式治疗效果的优良率[24-26,29]，锁骨钩钢板组126例, 克氏针组115例，异质性分析显示，各研究无明显异质性 (χ2=5.15，P=0.16)，故采用固定效应模型分析，RR=1.15，95%CI 1.04-1.28，P=0.005，结果显示两种内固定方式优良率差异有显著性意义(图2)。锁骨钩与纽扣钢板：2个随机对照试验报道了这两种方式治疗效果的优良率[27,30]，锁骨钩钢板组41例, 纽扣钢板组35例，异质性分析显示，各研究无明显异质性(χ2=0.00，P=0.96)，故采用固定效应模型分析，RR=0.86，95%CI 0.75-0.99，P=0.04，结果显示2种内固定方式优良率差异有显著性意义(图2)。锁骨钩与喙锁螺钉、惰性线：2个随机对照试验分别报道了锁骨钩与喙锁螺钉及惰性线治疗效果的优良率[25，28]，结果显示锁骨钩与它们之间的优良率差异无显著性意义(RR=0.96，95%CI 0.70-1.32，P=0.82；RR=1.00，95%CI 0.93-1.07，P=1.00，图2)。 2.6 肩关节疼痛Meta分析结果 2个随机对照试验报道了肩关节疼痛发生情况[25，29]，共90例，其中锁骨钩钢板组37例，克氏针组44例，喙锁螺钉9例。异质性分析显示，各研究无明显异质性(χ2=0.14，P=0.70)，故采用固定效应模型进行Meta分析，RR=8.39，95%CI 1.01-69.68，P=0.05，结果显示锁骨钩钢板治疗Ⅲ度肩锁关节脱位后肩关节疼痛与其他内固定方式比差异有显著性意义(图3)。 2.7 内固定物失效Meta分析结果 2个随机对照试验报道了内固定物失效发生情况[25，29]，共90例，其中锁骨钩钢板组37例，克氏针组44例，喙锁螺钉9例，因其中1个随机对照试验克氏针组未提及内固定失效情况[25]，单纳入喙锁螺钉进行对比分析。异质性分析显示，各研究无明显异质性(χ2=0.03，P=0.85)，故采用固定效应模型进行Meta分析，RR=0.17，95%CI 0.03-0.93，P=0.04，差异有显著性意义(图4)。"

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