Rockwood Ⅲ型肩锁关节脱位手术与保守治疗的疗效比较：系统评价和随机对照试验的荟萃分析。
Comparative efficacy of operative versus conservative treatment for Rockwood type III acromioclavicular joint dislocation: a systematic review and meta-analysis of randomized controlled trials.
机构信息
Department of Orthopedic, Taizhou Hospital of Zhejiang Province Affiliated to Wenzhou Medical University, Taizhou, Zhejiang, China.
Department of Orthopedic, Jiangsu Province （Suqian）Hospital, Suqian, Jiangsu, China.
出版信息
BMC Musculoskelet Disord. 2024 Nov 26;25(1):960. doi: 10.1186/s12891-024-08100-x.
BACKGROUND
Optimal management of Rockwood type III acromioclavicular joint (ACJ) dislocation is still debated. Our aim is to conduct a meta-analysis of clinical studies evaluating the functional outcomes of operative versus conservative treatment for Rockwood type III ACJ dislocation.
METHODS
We conducted a systematic search across PubMed, EMBASE, Web of Science, and the Cochrane Library, including only randomized controlled trials (RCTs) focusing exclusively on type III ACJ dislocation. A total of 244 patients from four studies were included. Outcomes measured included Constant scores (CS), coracoclavicular distance (CCD), pain, and complication rates. Heterogeneity was assessed and managed to ensure robust conclusions.
RESULTS
The pooled results showed no significant difference in long-term functional outcomes, measured by CS, between surgical and conservative treatments (MD: 4.82, 95% CI: -6.42 to 16.06, P = 0.400). Surgical treatment provided better early pain relief and superior CCD at all follow-up points but did not improve long-term outcomes. Complication rates were similar for both treatments, though surgical intervention had a higher incidence of posttraumatic osteoarthritis and hardware-related issues. Conservative treatment resulted in fewer complications and comparable long-term results.
CONCLUSIONS
Based on the evidence, while surgical treatment may offer early benefits in pain relief and CCD improvement, it does not enhance long-term functional outcomes and is associated with higher specific complication rates. Conservative treatment provides a viable alternative with fewer complications and similar long-term outcomes. These findings highlight the need for individualized treatment plans based on patient-specific factors and suggest further high-quality, long-term studies to refine management strategies for Type III AC joint dislocations.
背景
Rockwood Ⅲ型肩锁关节（ACJ）脱位的最佳治疗方法仍存在争议。我们的目的是对评估手术与保守治疗 Rockwood Ⅲ型 ACJ 脱位的功能结果的临床研究进行荟萃分析。
方法
我们对 PubMed、EMBASE、Web of Science 和 Cochrane 图书馆进行了系统检索，仅纳入专门针对Ⅲ型 ACJ 脱位的随机对照试验（RCT）。共有来自四项研究的 244 名患者纳入本研究。测量的结局包括 Constant 评分（CS）、肩锁关节间距（CCD）、疼痛和并发症发生率。评估并处理了异质性，以确保得出稳健的结论。
结果
汇总结果显示，手术与保守治疗在长期功能结局（CS）方面无显著差异（MD：4.82，95%CI：-6.42 至 16.06，P=0.400）。手术治疗在所有随访点均能更早地缓解疼痛，改善 CCD，但不能改善长期结局。两种治疗方法的并发症发生率相似，但手术干预后创伤性骨关节炎和与内固定相关的问题发生率更高。保守治疗导致的并发症更少，且长期结局相似。
结论
基于现有证据，虽然手术治疗可能在缓解疼痛和改善 CCD 方面提供早期获益，但并不能提高长期功能结局，且与更高的特定并发症发生率相关。保守治疗是一种可行的替代方案，并发症更少，长期结局相似。这些发现强调了根据患者特定因素制定个体化治疗计划的必要性，并提示需要进一步开展高质量、长期研究来完善Ⅲ型 AC 关节脱位的管理策略。
Zotero 插件