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切开与关节镜下Latarjet手术治疗肩关节前向不稳临床疗效的Meta分析
Hits: 3568   Download times: 913   Received:March 26, 2021    
作者Author单位UnitE-Mail
张晟 ZHANG Sheng 中国中医科学院望京医院关节四科, 北京 100102 The Forth Department of Joint, Wangjing Hospital of China Academy of Chinese Medical Science, Beijing 100102, China  
张磊 ZHANG Lei 中国中医科学院望京医院关节四科, 北京 100102 The Forth Department of Joint, Wangjing Hospital of China Academy of Chinese Medical Science, Beijing 100102, China arthroartist@163.com 
韩庆欣 HAN Qing-xin 中国中医科学院望京医院关节四科, 北京 100102 The Forth Department of Joint, Wangjing Hospital of China Academy of Chinese Medical Science, Beijing 100102, China  
孙晋 SUN Jin 中国中医科学院望京医院关节四科, 北京 100102 The Forth Department of Joint, Wangjing Hospital of China Academy of Chinese Medical Science, Beijing 100102, China  
马佳 MA Jia 中国中医科学院望京医院关节四科, 北京 100102 The Forth Department of Joint, Wangjing Hospital of China Academy of Chinese Medical Science, Beijing 100102, China  
刘晓华 LIU Xiao-hua 中国中医科学院望京医院关节四科, 北京 100102 The Forth Department of Joint, Wangjing Hospital of China Academy of Chinese Medical Science, Beijing 100102, China  
姜博 JIANG Bo 中国中医科学院望京医院关节四科, 北京 100102 The Forth Department of Joint, Wangjing Hospital of China Academy of Chinese Medical Science, Beijing 100102, China  
李妍 LI Yan 中国中医科学院望京医院关节四科, 北京 100102 The Forth Department of Joint, Wangjing Hospital of China Academy of Chinese Medical Science, Beijing 100102, China  
石慧生 SHI Hui-sheng 中国中医科学院望京医院关节四科, 北京 100102 The Forth Department of Joint, Wangjing Hospital of China Academy of Chinese Medical Science, Beijing 100102, China  
期刊信息：《中国骨伤》2021年34卷，第6期，第573-583页
DOI：10.12200/j.issn.1003-0034.2021.06.019


目的： 通过Meta分析比较切开与关节镜下Latarjet手术治疗肩关节前向不稳的临床疗效差异。

方法： 计算机检索PubMed、Medline、Embase、Cochrane、中国知网、万方、中国生物医学文献数据库和维普数据库，以查找关于切开和关节镜下Latarjet手术治疗肩关节前向不稳的回顾性或前瞻性队列研究或随机对照试验。选择二分类变量，如术后复发率、术中及术后并发症发生率；以及连续型变量，如肩关节外旋活动度，Walch-Duplay评分，Rowe评分，西安大略肩关节不稳指数（Western Ontario Shoulder Instability Index，WOSI）评分，术后视觉模拟评分（visual analogue scale，VAS），术后患者焦虑程度，手术时间和螺钉置入角度等结局指标进行分析。采用NOS偏倚风险评估标准（Cochrane协作网推荐）评价回顾性或前瞻性队列研究的文献质量，随机对照试验的质量评价采用改良Jadad量表。由2人独立进行文献筛选、文献质量评价及数据提取。使用RevMan 5.3软件进行Meta分析。

结果： （1）共纳入9篇文献，其中8篇回顾性队列研究和1篇前瞻性队列研究，研究证据级别较低，共纳入956例患者，其中切开Latarjet手术436例，关节镜下Latarjet手术520例。（2）Meta分析结果显示，切开组术后肩关节WOSI评分优于关节镜下组（MD=93.74，95%CI：26.00~161.49，P=0.007），且螺钉置入角度明显小于关节镜组（MD=-6.44，95%CI：-12.08~0.81，P=0.02）。（3）切开Latarjet手术复发率低于关节镜下Latarjet手术，但二者差异无统计学意义（OR=0.84，95%CI：0.23~3.05，P=0.79）。（4）在肩关节外旋活动度、Walch-Duplay评分、Rowe评分、术后视觉模VAS评分、术后患者焦虑程度和手术时间等方面切开和关节镜下Latarjet手术之间差异无统计学意义（P>0.05）。

结论： 切开和关节镜下Latarjet手术治疗肩关节前向不稳均能取得良好的临床疗效，且术后复发脱位率及并发症较低。切开和镜下Latarjet均为治疗肩关节前向不稳的可靠手术方式。但镜下手术较切开手术学习曲线长，需要一定量的手术积累，因此临床医生可根据手术技术熟练程度、喜好和患者的情况等因素选择镜下或切开手术。但研究中所纳入的文献皆为队列研究，证据等级不高，缺少随机对照试验，且样本量较小，未来仍需要大样本量、高证据等级的随机对照研究来确定两者之间的疗效差异。
[关键词]:Latarjet术  肩关节  肩脱位  关节镜  Meta分析
 
Comparison of the efficacy between open and arthroscopic Latarjet procedure in the treatment of anterior shoulder instability: a Meta-analysis
Abstract:

Objective: To compare the clinical efficacy between open and arthroscopic Latarjet procedure in the treatment of anterior shoulder instability by using Meta-analysis.

Methods: Search PubMed,Medline,Embase,Cochrane,China National Knowledge Infrastructure(CNKI),Wanfang database,China Biological Literature system(CBM) and VIP database. Review all retrospective or prospective cohort studies and randomized controlled trials on open and arthroscopic Latarjet procedure for anterior shoulder instability. Binary variables(postoperative recurrence rate,incidence of intraoperative and postoperative complications) and continuous variables[shoulder external rotation range of motion,Walch-Duplay score,Rowe score,WOSI score,postoperative visual analogue scale (VAS),postoperative anxiety degree and operation time] were selected for analysis. NOS bias risk assessment criteria (recommended by Cochrane collaboration Network) were used to evaluate the literature quality of retrospective or prospective cohort studies,and modified Jadad scale was used to evaluate the quality of randomized controlled trials. Literature screening,literature quality evaluation and data extraction were carried out independently by two observers. RevMan 5.3 software was used for Meta analysis.

Results: (1) A total of 9 studies were included,including 8 retrospective cohort studies and 1 prospective cohort study. A total of 956 patients were included in this study,including open Latarjet procedure(n=436) and arthroscopic Latarjet procedure(n=520). (2) The postoperative WOSI score in the open group was better than that of arthroscopic group (MD=93.74,95%CI:26.00 to 161.49,P=0.007),and the α angle was smaller than arthroscopic group(MD=-6.44,95%CI:-12.08 to 0.81,P=0.02). (3) The recurrence rate of open Latarjet group was lower than that of arthroscopic Latarjet group,but there was no significant difference between the two groups(OR=0.84,95%CI:0.23 to 3.05,P=0.79). (4) There were no significant difference in shoulder external rotation,Walch-Duplay score,Rowe score,postoperative visual analogue score,postoperative anxiety degree and operation time between open and arthroscopic Latarjet group.

Conclusion: The arthroscopic Latarjet stabilisation shows satisfactory and comparable results to open procedure,and the postoperative recurrence and complication rates are low in both group. Both open and arthroscopic Latarjet procedure are reliable surgical procedures in the treatment of anteriorly shoulder instability. Arthroscopic procedure has longer learning curve than open procedure,the doctors may either choose arthroscopic or open Latarjet procedure based on personal skills and preference,as well as the patient's condition. However,all the literatures included in this study are cohort studies with low level of evidence. The research lack randomized controlled trials,and small sample size is small. In the future,randomized controlled studies with large sample size and high level of evidence are still needed to determine the efficacy difference between the two.
KEYWORDS:Latarjet  Shoulder joint  Shoulder dislocations  Arthroscopes  Meta-analysis
 
引用本文，请按以下格式著录参考文献：
中文格式:张晟,张磊,韩庆欣,孙晋,马佳,刘晓华,姜博,李妍,石慧生.切开与关节镜下Latarjet手术治疗肩关节前向不稳临床疗效的Meta分析[J].中国骨伤,2021,34(6):573~583
英文格式:ZHANG Sheng,ZHANG Lei,HAN Qing-xin,SUN Jin,MA Jia,LIU Xiao-hua,JIANG Bo,LI Yan,SHI Hui-sheng.Comparison of the efficacy between open and arthroscopic Latarjet procedure in the treatment of anterior shoulder instability: a Meta-analysis[J].zhongguo gu shang / China J Orthop Trauma ,2021,34(6):573~583
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