Medical School, Faculty of Health Sciences, University of Pretoria, Pretoria, South Africa.
Department of Orthopaedic Surgery and Sports Medicine, Burjeel Hospital for Advanced Surgery, Dubai, UAE.
Eur J Orthop Surg Traumatol. 2023 Oct;33(7):2831-2846. doi: 10.1007/s00590-023-03492-3. Epub 2023 Feb 25.
The purpose of this study was to perform a systematic review and meta-analysis of both randomized controlled and observational studies comparing double-button suture fixation to hook plate fixation for types III-IV acromioclavicular joint dislocation.
Systematic review of Medline, Embase, Scopus, and Google Scholar, including all levels 1-3 studies from 2000 to 2022. Clinical outcome scores, range of motion, and complications were included. Risk of bias was assessed using the Cochrane Collaboration's ROB2 tool and ROBINs-I tool. MINORS and modified Coleman Methodology Score (CMS) were used to assess within study quality. The GRADE system was used to assess the overall quality of the body of evidence. Heterogeneity was assessed using χ and I statistics.
Fifteen studies were included. Three of the four included LOE II and eleven of the LOE III studies had a high risk of bias. Study quality was considered poor and fair for 67% by MINORS criteria and 93% for CMS criteria. The pooled estimate (SMD 0.662) for all clinical outcomes was statistically significant and in favor of button repair (p = 0.0001). The pooled estimate (SMD 0.662) for all VAS pain scores was statistically significant, again in favor of button repair (p = 0.001).
The results of this meta-analysis demonstrated significantly better outcomes of button repair for acute ACJ dislocations when compared to clavicle hook plate. Button repair is also associated with a 2.2 times lower risk for complications. However, risk of bias is high, and study quality within and between studies was low. These results, therefore, must be viewed with caution.
Level III; systematic review and meta-analysis.
本研究的目的是对比较双按钮缝线固定与钩板固定治疗 III-IV 型肩锁关节脱位的随机对照和观察性研究进行系统评价和荟萃分析。
对 2000 年至 2022 年期间的 Medline、Embase、Scopus 和 Google Scholar 进行系统评价，包括所有 1-3 级研究。纳入临床结局评分、活动范围和并发症。使用 Cochrane 协作的 ROB2 工具和 ROBINs-I 工具评估偏倚风险。使用 MINORS 和改良 Coleman 方法学评分 (CMS) 评估研究内质量。使用 GRADE 系统评估证据总体质量。使用 χ 和 I 统计评估异质性。
共纳入 15 项研究。四项研究中的三项为 LOE II，11 项研究为 LOE III，偏倚风险高。根据 MINORS 标准，67%的研究质量被认为较差，93%的研究质量被认为是 CMS 标准。所有临床结局的汇总估计（SMD 0.662）具有统计学意义，且有利于按钮修复（p=0.0001）。所有 VAS 疼痛评分的汇总估计（SMD 0.662）具有统计学意义，再次有利于按钮修复（p=0.001）。
这项荟萃分析的结果表明，与锁骨钩板相比，急性肩锁关节脱位的按钮修复具有明显更好的结果。按钮修复还与并发症风险降低 2.2 倍相关。然而，偏倚风险高，且研究内和研究间的研究质量较低。因此，这些结果必须谨慎看待。
III 级；系统评价和荟萃分析。
