Meta-analysis on endobutton plate versus the other fixation methods for acromioclavicular joint dislocation

doi:10.3969/j.issn.2095-4344.2014.40.027

Abstract

Abstract:

BACKGROUND: At present, the anatomic reconstruction of coracoclavicular ligament is a trend for the treatment of acromioclavicular joint dislocation. Endobutton plate is a new and effective surgical method found in recent years. Although the recent curative effect is satisfactory, as a method of internal fixation, its rigid fixation does not conform to the requirements of the biomechanics. Furthermore, a randomized controlled clinical study and systematic evaluation are absent.

OBJECTIVE: To systematically evaluate clinical outcomes and safety between endobutton plate and the other surgical methods for treatment of acromioclavicular joint dislocation.

METHODS: Cochrane (2014-01), PubMed (1966-01/2014-03), Medline (1966-01/2014-03), EMbase (1984-01/2014-03), CNKI (1979-01/2014-03), VIP (1989-01/2014-03) and Wanfang (1989-01/2014-03) databases were searched by computer. Six Chinese journals 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 acromioclavicular joint dislocation were collected. In accordance with inclusion criteria, some literatures were included and their qualities were assessed strictly. Meta-analysis was performed with RevMan 5.2 software from the Cochrane Collaboration.

RESULTS AND CONCLUSION: Finally 7 published studies with randomized controlled trials met all the inclusion criteria. A total of 359 patients were included, containing 152 cases of endobutton plates fixation, 149 cases of clavicle hook plate fixation, and 58 cases of screw fixation. Except two researches addressed the comparison among three surgical ways, the remaining were about two ways. Meta-analysis showed that the excellent rate was better in endobutton plates fixation than in clavicle hook plate fixation (P=0.0002) and in screw fixation (P=0.009). Compared with other fixation methods, there were significant differences in shoulder joint pain (P=0.01), but no significant difference was detected in operation time, upper limb muscle strength, bleeding amount, redislocation and surgical wound infection (P=0.44, P=0.10, P=0.37, P=0.21, P=0.96). Results indicated that, the efficiency of endobutton plates fixation for acromioclavicular joint dislocation was better than clavicle hook plate fixation and screw fixation, and caused less shoulder pain than clavicle hook plate fixation. There was no significant difference in operation time, upper limb muscle strength, bleeding amount, redislocation and surgical wound infection among the three methods. Due to the limited number of cases in this study, the multicenter, large-sample and long-term clinical randomized controlled studies are needed 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: internal fixators, acromioclavicular joint, randomized controlled trial, evidence-based medicine, Meta-analysis

CLC Number:

R318

Wang Zhi-zhou, Qu Guang-hua, Han Ya-jun, Xu Chao, Yilihamu•Tuoheti. Meta-analysis on endobutton plate versus the other fixation methods for acromioclavicular joint dislocation[J]. Chinese Journal of Tissue Engineering Research, 2014, 18(40): 6553-6561.

Figures/Tables 5

2.1 文献检索结果输入检索词后初检到相关文献264篇，经仔细阅读文题及摘要后，并排除重复发表的研究以及回顾性研究，从而得到肩锁关节脱位纽扣钢板内固定治疗随机研究的文献46篇，最后通过全文阅读，电话询问作者及仔细阅读原文并提取资料，排除39篇不符合纳入标准的文献，最终纳入7篇文献。 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[10-16]。 2.3 纳入研究对象及一般情况 7个研究共纳入359例患者，其中纽扣钢板实验组152例，锁骨钩钢板对照组共149例，喙锁螺钉对照组共58例。其中只有2个研究是3种不同方式比较，余均为2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由2名评价者独立根据预定的纳入和排除标准筛选文献、进行质量评价和资料提取，如存在分歧则通过协商或征求第3方意见解决。按照Cochrane系统评价员手册对每篇符合纳人和排除标准的文献进行方法学质量评价(表2)。 2.5 优良率Meta分析结果纽扣钢板与锁骨钩钢板：5个随机对照试验报道了这2种方式治疗效果的优良率(karlsson评定标准)[10-12,14,16]，纽扣钢板组110例，锁骨钩钢板组119例，异质性分析显示，各研究无明显异质性[Chi2=1.94，df=4(P=0.75)，I2=0%]，采用固定效应模型进行分析，OR=5.46，95%CI(2.22，13.43)，P=0.000 2，结果显示2种内固定方式优良率差异有显著性意义(图1)。纽扣钢板和喙锁螺钉：2个随机对照试验报道了这两种方式治疗效果的优良率(karlsson评定标准)[11，14]，纽扣钢板组44例, 喙锁螺钉组44例，异质性分析显示，各研究无明显异质性[Chi2=1.23，df=1(P=0.27)，I2=19%]，采用固定效应模型进行分析，OR=4.34，95%CI(1.43，13.13)，P=0.009，结果显示2种内固定方式优良率差异有显著性意义(图1)。 2.6 肩关节疼痛Meta分析结果 3个随机对照试验报道了肩关节疼痛发生情况[10，15-16]，共138例，其中纽扣钢板组64例，锁骨钩钢板组74例，异质性分析显示，各研究无明显异质性[Chi2=0.13，df=2(P=0.95)，I2=0%]，故采用固定效应模型进行分析，OR=0.11，95%CI(0.02，0.60)，P=0.01，结果显示纽扣钢板修复肩锁关节脱位后肩关节疼痛与其他内固定方式比较差异有显著性意义(图2)。 2.7 治疗后上肢肌力Meta分析结果 3个随机对照试验报道固定后上肢肌力情况[10，15-16]，共138例。其中纽扣钢板组64例，锁骨钩钢板组74例，以肌力为5级或4级的患者疗效评定为优良，以肌力≤3的患者疗效评定为差进行统计学分析。异质性分析显示，各研究无明显异质性[Chi2= 0.03，df=1(P=0.86)，I2=0%]，故采用固定效应模型进行分析，OR=6.15，95%CI(0.71，53.17)，P=0.10，结果显示纽扣钢板治疗肩锁关节脱位后上肢肌力与其他内固定方式比较差异无显著性意义(图3)。 2.8 复位丢失(再脱位)Meta分析结果 3个随机对照试验报道手术后复位丢失(再脱位)情况[12-13,15]，共146例。其中纽扣钢板组72例，锁骨钩钢板组60例，喙锁螺钉14例。异质性分析显示，各研究无明显异质性[Chi2=0.09，df=1 (P=0.76)，I2=0%]，故采用固定效应模型进行分析OR=0.24，95%CI(0.03，2.21)，P=0.21，结果显示纽扣钢板修复肩锁关节脱位后复位丢失(再脱位)与其他内固定方式比较差异无显著性意义(图4)。 2.9 术后伤口感染Meta分析结果 4个随机对照试验报道手术后伤口感染情况[10,12-13,16]，共168例。其中纽扣钢板组80例，锁骨钩钢板组74例，喙锁螺钉14例。异质性分析显示，各研究无明显异质性[Chi2=0.88，df=1(P=0.35)，I2=0%]，故采用固定效应模型进行分析，OR=1.05，95%CI(0.14，7.93)，P=0.96，结果显示纽扣钢板修复肩锁关节脱位后伤口感染与其他内固定方式比较差异无显著性意义(图5)。 2.10 术中出血量Meta分析结果 2个随机对照试验报道术中出血量情况[12，16]，共98例。其中纽扣钢板组48例，锁骨钩钢板组50例。异质性分析显示，各研究有明显异质性[Chi2=53.69，df=1(P < 0.000 01)，I2=98%]，故采用随机效应模型进行分析，MD=14.22，95%CI(-16.75，45.18)，P=0.37，结果显示纽扣钢板修复肩锁关节脱位术中出血量与其他内固定方式比较差异无显著性意义(图6)。 2.11 手术时间Meta分析结果 2个随机对照试验报道手术时间情况[12，16]，共98例。其中纽扣钢板组48例，锁骨钩钢板组50例。异质性分析显示，各研究有明显异质性[Chi2=28.82，df=1(P < 0.000 01)，I2=97%]，故采用随机效应模型进行分析，MD=15.08，95%CI(-23.42，53.58)，P=0.44，结果显示纽扣钢板修复肩锁关节脱位手术时间与其他内固定方式比较差异无显著性意义(图7)。"

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