肩锁关节的解剖重建可提供慢性不稳定治疗的最佳功能结果。
Anatomic reconstruction of the acromioclavicular joint provides the best functional outcomes in the treatment of chronic instability.
机构信息
Orthopaedics Institute, Fondazione Policilinico Universitario A. Gemelli IRCCS, Largo A. Gemelli 8, 00168, Rome, Italy.
Department of Medical and Surgical Specialties, Radiological Sciences, and Public Health, University of Brescia, Brescia, Italy.
出版信息
Knee Surg Sports Traumatol Arthrosc. 2021 Jul;29(7):2237-2248. doi: 10.1007/s00167-020-06059-5. Epub 2020 May 27.
PURPOSE
To systematically review the outcomes of surgical treatments of chronic acromioclavicular joint dislocation.
METHODS
Studies were identified by electronic databases (Ovid, PubMed). All studies reporting functional and radiological outcomes of surgical treatments of chronic acromioclavicular joint dislocations were included. Following data were extracted: authors and year, study design, level of evidence, number of patients, age, classification of acromioclavicular joint dislocation, time to surgery, surgical technique, follow-up, clinical and imaging outcomes, complications and failures. Descriptive statistics was used, when a data pooling was not possible. Comparable outcomes were pooled to generate summary outcomes reported as frequency-weighted values. Quality appraisal was assessed through the MINORS checklist.
RESULTS
Fourty-four studies were included for a total of 1020 shoulders. Mean age of participants was 38 years. Mean follow-up was 32.9 months. Arthroscopic techniques showed better results than open approach (p < 0.0001). Synthetic reconstructions demonstrated better functional outcomes compared to internal fixation and biologic techniques (p < 0.0001). Among biologic techniques, combined coracoclavicular and acromioclavicular ligaments reconstruction showed better Constant (p = 0.0270) and ASES (p = 0.0113) scores compared to isolated coracoclavicular ligaments reconstruction; anatomic biologic non-augmented graft reconstruction showed better Constant (p < 0.0001), VAS (p < 0.0001) and SSV (p = 0.0177) results compared to augmented techniques. No differences in functional outcomes could be found between anatomic biologic non-augmented graft versus synthetic reconstructions. Overall, methodological quality of the included studies was low.
CONCLUSION
Anatomic reconstructions, both synthetic and biologic, showed the best functional results.
LEVEL OF EVIDENCE
IV.
目的
系统评价慢性肩锁关节脱位手术治疗的结果。
方法
通过电子数据库（Ovid、PubMed）进行研究检索。纳入所有报告慢性肩锁关节脱位手术治疗的功能和影像学结果的研究。提取的资料包括：作者和年份、研究设计、证据水平、患者数量、年龄、肩锁关节脱位分类、手术时间、手术技术、随访、临床和影像学结果、并发症和失败。当不能进行数据汇总时，使用描述性统计。汇总可比结局，以生成以频率加权值报告的汇总结局。使用 MINORS 清单进行质量评估。
结果
共纳入 44 项研究，共计 1020 例肩关节。参与者的平均年龄为 38 岁。平均随访时间为 32.9 个月。关节镜技术的结果优于开放入路（p<0.0001）。合成重建的功能结果优于内固定和生物技术（p<0.0001）。在生物技术中，与单独的喙锁韧带重建相比，喙锁和肩锁韧带联合重建显示出更好的 Constant（p=0.0270）和 ASES（p=0.0113）评分；解剖生物非增强移植物重建显示出更好的 Constant（p<0.0001）、VAS（p<0.0001）和 SSV（p=0.0177）结果，与增强技术相比。在功能结果方面，解剖生物非增强移植物与合成重建之间没有差异。总体而言，纳入研究的方法学质量较低。
结论
解剖重建，无论是合成的还是生物的，都显示出最好的功能结果。
证据水平
IV。
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