目的

评估不同方式治疗肩锁关节脱位的疗效，并探讨在Double-Endobutton 钢板治疗肩锁关节脱位中修复肩锁韧带的必要性。

方法

检索 PubMed、Embase、Cochrane Library、CNKI、WF、VIP、Sinomed 等，检索国内外公开发表的中、英文文献，按纳入及排除标准筛选文献，检索年限为建库至2024 年5 月15 日。采用 RevMan 5.3 和Stata 16 软件进行网状Meta 分析。

结果

最终纳入23 篇文献，其中随机对照试验11 篇、病例对照研究12 篇，共纳入1 496 例患者。网状Meta分析结果表明：与锁骨钩钢板（clavicular hook plate，CHP）术相比，Double-Endobutton 及Double-Endobutton 联合肩锁韧带修复均能降低术后并发症发生率，增强术后肩关节功能，改善术后疼痛，且差异具有统计学意义。累计概率排序结果显示：（1）手术时间：CHP ＞Double-Endobutton ＞Double-Endobutton 联合肩锁韧带修复；（2）术中出血量：Double-Endobutton ＞CHP ＞Double-Endobutton联合肩锁韧带修复；（3）术后并发症发生率、肩关节Constant-Murley 评分（Constant shoulder score，CM）及术后Karlsson 评分优良率：Double-Endobutton 联合肩锁韧带修复＞Double-Endobutton ＞CHP；（4）视觉模拟评分：Double-Endobutton ＞Double-Endobutton 联合肩锁韧带修复＞CHP。

结论

总体来说，Double-Endobutton 及Double-Endobutton 联合肩锁韧带修复两种术式在降低术后并发症，增强术后肩关节功能，改善术后疼痛方面优于CHP 术；Double-Endobutton 联合肩锁韧带修复相较于Double-Endobutton 降低术后并发症发生率的效果更佳，其余结局指标相比效果相当，今后仍需更多关于Double-Endobutton 联合肩锁韧带修复的高质量、大样本、多中心的随机对照试验进一步证实。

Background

Acromioclavicular dislocation is a common shoulder injury in orthopedics.The surgical treatment of acromioclavicular dislocation is varied and controversial. In past clinical practice，rigid fixation schemes， such as clavicular hook plate surgery， were mainly used， but with the deepening of people's understanding of acromioclavicular joints， elastic fixation schemes have gradually been recognized by people. A double-Endobutton plate in an elastic fixation scheme has become the primary surgical method for treating acromioclavicular dislocation. However， some scholars believe that double-Endobutton plate surgery only focuses on the reconstruction of the coracoclavicular ligament， ignoring the repair of the acromioclavicular ligament， resulting in an increase in the incidence of postoperative complications such as shoulder instability. Therefore， exploring the excellent clinical effect of different surgical methods in treating acromioclavicular dislocation has become one of the current research hotspots.

Objective

To evaluate the efficacy of different methods in treating acromioclavicular dislocation and to discuss the necessity of repairing the acromioclavicular ligament in treating acromioclavicular dislocation with the double-Endobutton plate.

Methods

PubMed， Embase， Cochrane Library， CNKI， WF， VIP， and Sinomed were searched for published Chinese and English literature at home and abroad， and the literature was screened according to inclusion and exclusion criteria. The retrieval period was from May 15， 2024. The mesh metaanalysis was performed using RevMan 5.3 and Stata 16 software.

Results

A total of 24 pieces of literature were included， including 11 randomized controlled trials and 13 case-control studies involving 1 496 patients. The results of mesh meta-analysis showed that compared with CHP， both double-Endobutton and double-Endobutton combined with acromioclavicular ligament repair could reduce the incidence of postoperative complications， enhance postoperative shoulder joint function， and improve postoperative pain， and the differences were statistically significant. The cumulative probability ranking results showed that：operation time：CHP ＞ double-Endobutton ＞ double-Endobutton combined with acromioclavicular ligament repair； Intraoperative blood loss：double-Endobutton ＞ CHP ＞ double-Endobutton combined with acromioclavicular ligament repair； Postoperative complication rate， CM score， and Karlsson score were as follows：double Endobutton combined with acromioclavicular ligament repair ＞ double Endobutton ＞CHP； VAS score：double-Endobutton ＞ double-Endobutton combined acromioclavicular ligament repair ＞CHP.

Conclusion

Overall， double-Endobutton alone and its combination with acromioclavicular ligament repair are superior to CHP surgery in reducing postoperative complication rates， improving postoperative shoulder joint function， and alleviating postoperative pain. The reduction in postoperative complication rates is even more significant when using double-Endobutton in combination with ACJL repairs than when using it alone. Other outcome indicators show similar effects between these two procedures. However， more highquality， large-sample， and multi-center randomized controlled trials are still needed to confirm further the effectiveness of double-Endobutton in combination with ACJL repairs.