Xie Chengxin, Hong Zhenghua, Su Yongwei, Jiang Jiao, Luo Hua
Department of Orthopedics, Taizhou Hospital of Zhejiang Province Affiliated to Wenzhou Medical University, Taizhou, China.
Department of Orthopedics, The First Affiliated Hospital of Jinzhou Medical University, Jinzhou, China.
Arthroscopy. 2024 Oct 10. doi: 10.1016/j.arthro.2024.09.055.
To systematically review the current evidence to compare the differences in outcomes of suture button (SB) versus hook plate (HP) fixation for treating acute Rockwood type III acromioclavicular joint (ACJ) dislocation.
Two reviewers independently conducted a literature search based on the Preferred Reporting Items for Systematic Reviews and Meta-analyses guidelines. PubMed, Embase, MEDLINE, and the Cochrane Library were systematically searched for studies comparing SB and HP in the treatment of acute Rockwood type III ACJ dislocation. Constant score, visual analog scale (VAS) score, coracoclavicular distance, operation time, and occurrence of complications were assessed. Risk of bias was assessed using The Cochrane Collaboration and Risk Of Bias In Non-randomized Studies-of Interventions tools.
A total of 16 studies were included, consisting of 2 randomized controlled trials and 14 non-randomized controlled trials, with 471 patients in the SB group and 445 patients in the HP group. Among the included studies that reported patient-reported outcomes, 4 indicated significantly higher Constant scores in the SB group compared with the HP group whereas the remaining 5 found no difference between the groups. Among the 5 included studies that reported VAS scores, 2 showed statistically significant differences favoring the SB group. Among the 10 included studies that reported operation time, 3 found a shorter operation time in the SB group than in the HP group whereas 2 indicated a longer operation time for SB surgery compared with HP treatment. However, there was no statistically significant difference in coracoclavicular distance or the incidence of complications between the 2 groups.
The evidence suggests no clear clinical superiority of SBs over HPs in treating acute Rockwood type III ACJ dislocations. Whereas some studies show that SB treatment may offer benefits such as higher Constant scores and lower VAS scores, most outcomes reveal no significant differences. LEVEL OF EVIDENCE: Level Ⅲ, systematic review of Level II and Ⅲ studies.
系统回顾当前证据，比较缝线纽扣（SB）与钩钢板（HP）固定治疗急性RockwoodⅢ型肩锁关节（ACJ）脱位的疗效差异。
两名研究者根据系统评价和Meta分析的首选报告项目指南独立进行文献检索。系统检索PubMed、Embase、MEDLINE和Cochrane图书馆，查找比较SB和HP治疗急性RockwoodⅢ型ACJ脱位的研究。评估Constant评分、视觉模拟量表（VAS）评分、喙锁距离、手术时间和并发症发生率。使用Cochrane协作网和干预性非随机研究中的偏倚风险工具评估偏倚风险。
共纳入16项研究，包括2项随机对照试验和14项非随机对照试验，SB组471例患者，HP组445例患者。在报告患者报告结局的纳入研究中，4项研究表明SB组的Constant评分显著高于HP组，而其余5项研究发现两组之间无差异。在报告VAS评分的5项纳入研究中，2项显示SB组有统计学显著差异。在报告手术时间的10项纳入研究中，3项发现SB组的手术时间比HP组短，而2项表明SB手术的手术时间比HP治疗长。然而，两组之间的喙锁距离或并发症发生率无统计学显著差异。
证据表明，在治疗急性RockwoodⅢ型ACJ脱位方面，SB并不比HP具有明显的临床优势。虽然一些研究表明SB治疗可能具有如更高的Constant评分和更低的VAS评分等益处，但大多数结局显示无显著差异。证据级别：Ⅲ级，对Ⅱ级和Ⅲ级研究的系统评价。
