Lee Chih-Yao, Chen Po-Cheng, Liu Ying-Chun, Tsai Yun-Che, Chou Pei-Hsi, Fu Yin-Chih, Liu Wen-Chih, Jupiter Jesse Bernard
Department of Orthopedic Surgery, Kaohsiung Medical University Hospital, Kaohsiung Medical University, 807, Kaohsiung, Taiwan.
Department of Physical Medicine and Rehabilitation, Kaohsiung Chang Gung Memorial Hospital, College of Medicine, Chang Gung University, Kaohsiung, Taiwan.
BMC Musculoskelet Disord. 2022 Mar 4;23(1):205. doi: 10.1186/s12891-022-05142-x.
Acromioclavicular joint (ACJ) dislocation is a common shoulder injury. In treating acute unstable ACJ dislocation, a hook plate (HP) is a straightforward and popular option for ensuring proper reduction and rigid fixation while promoting AC and coracoclavicular (CC) ligament healing. Surgeons typically remove the HP to prevent subacromial impingement and acromial osteolysis; however, concerns about redislocation after implant removal remain. Therefore, additional CC augmentation may be helpful in combination with HP fixation. The aim of this meta-analysis is to compare the outcomes and complications of HP fixation with or without additional CC augmentation for acute unstable ACJ dislocation.
We searched the PubMed, EMBASE, and Web of Science databases for relevant case-control studies. The primary outcomes were patient-reported outcome measures; the secondary outcomes were pain measured using a visual analog scale (VAS), CC distance (CCD), and complications. Continuous data were assessed using weighted standardized mean differences (SMDs) with 95% confidence intervals (CIs), and dichotomous data were evaluated with Mantel-Haenszel odds ratio (ORs) with 95% CIs.
We analyzed one randomized control trial and four case-control studies comparing HP fixation with or without CC augmentation. A total of 474 patients with Rockwood type III or V ACJ dislocation were included. We found no differences in Constant-Murley score (SMD, - 0.58, 95% CI - 1.41 to 0.26; P = 0.18), American Shoulder and Elbow Surgeons score (SMD, 0.21, 95% CI - 0.10 to 0.52; P = 0.19), University of California at Los Angeles shoulder rating scale score (SMD, - 0.02, 95% CI - 1.27 to 1.23; P = 0.97), or VAS pain score (SMD, 0.36, 95% CI - 0.16 to 0.88; P = 0.17) between groups. The CC augmentation group had lower odds of osteolysis (OR, 0.27, 95% CI 0.10 to 0.74; P = 0.01) and a shorter CCD (SMD, - 0.29, 95% CI - 0.57 to - 0.01; P = 0.04).
HP fixation with CC augmentation is preferable for acute unstable ACJ dislocations. Although CC augmentation did not provide additional benefits related to functional outcomes or pain, it resulted in greater reduction maintenance after implant removal and a 73% lower risk of acromial osteolysis.
PROSPERO ( CRD42021271118 ).
肩锁关节（ACJ）脱位是一种常见的肩部损伤。在治疗急性不稳定型ACJ脱位时，钩钢板（HP）是一种直接且常用的选择，可确保正确复位和坚强固定，同时促进肩锁（AC）和喙锁（CC）韧带愈合。外科医生通常会取出HP以防止肩峰下撞击和肩峰骨质溶解；然而，对于取出植入物后再脱位的担忧仍然存在。因此，额外的CC增强术与HP固定联合使用可能会有所帮助。本荟萃分析的目的是比较急性不稳定型ACJ脱位采用HP固定加或不加额外CC增强术的疗效和并发症。
我们在PubMed、EMBASE和科学网数据库中搜索相关的病例对照研究。主要结局是患者报告的结局指标；次要结局是使用视觉模拟量表（VAS）测量的疼痛、CC距离（CCD）和并发症。连续数据采用加权标准化均数差（SMD）及95%置信区间（CI）进行评估，二分数据采用Mantel-Haenszel比值比（OR）及95%CI进行评估。
我们分析了一项随机对照试验和四项病例对照研究，比较了HP固定加或不加CC增强术的情况。共纳入474例Rockwood III型或V型ACJ脱位患者。我们发现两组在Constant-Murley评分（SMD，-0.58，95%CI -1.41至0.26；P = 0.18）、美国肩肘外科医生评分（SMD，0.21，95%CI -0.10至0.52；P = 0.19）、加利福尼亚大学洛杉矶分校肩部评分量表评分（SMD，-0.02，95%CI -1.27至1.23；P = 0.97）或VAS疼痛评分（SMD，0.36，95%CI -0.16至0.88；P = 0.17）方面无差异。CC增强组骨质溶解的几率较低（OR，0.27，95%CI 0.10至0.74；P = 0.01），CCD较短（SMD，-0.29，95%CI -0.57至-0.01；P = 0.04）。
对于急性不稳定型ACJ脱位，采用HP固定并进行CC增强术更佳。虽然CC增强术在功能结局或疼痛方面未提供额外益处，但它在取出植入物后能更好地维持复位，且肩峰骨质溶解风险降低73%。
PROSPERO（CRD42021271118）
