Mohtadi Nicholas G H, Bitar Ivan J, Sasyniuk Treny M, Hollinshead Robert M, Harper Wade P
University of Calgary Sport Medicine Centre, Calgary, Alberta, Canada.
Arthroscopy. 2005 Jun;21(6):652-8. doi: 10.1016/j.arthro.2005.02.021.
The purpose of this study was to critically evaluate the literature to determine whether open or arthroscopic surgical repair for traumatic recurrent anterior shoulder instability results in a better outcome.
Meta-analysis.
The search involved clinical studies in all languages in the MEDLINE database from 1966 to October 31, 2003. The following key words were used: (1) anterior shoulder instability, (2) Bankart lesion, (3) traumatic recurrent anterior shoulder instability, and (4) arthroscopic and open Bankart repair. All abstracts were reviewed and articles were included if there was a direct clinical comparison between arthroscopic and open repair for traumatic recurrent anterior shoulder instability. These articles were manually cross-referenced for additional abstracts. The final group of articles was independently critically appraised and the following outcomes were extracted: recurrent instability, return to activity, reoperation rate, and cause of recurrence.
The search terms resulted in 677, 183, 68, and 51 hits respectively. From these, 18 articles were determined to be eligible for full review including 2 foreign-language articles. Cross-referencing identified 2 unpublished studies. Eleven studies were included in the final analysis: 1 randomized trial, 2 pseudo-experimental designs, 4 prospective cohorts, 3 retrospective studies, and 1 case control study. Pooled Mantel-Haenszel odds ratio for recurrent instability and return to activity were 2.04 ( P = .003; 95% confidence interval, 1.27, 3.29) and 2.85 ( P = .004; 95% confidence interval, 1.40, 5.78), respectively, in favor of the open repair.
Based on this meta-analysis, open repair has a more favorable outcome with respect to recurrence and return to activity.
Level III, Systematic Review of Level III (and II/I) Studies.
本研究的目的是严格评估文献，以确定开放性手术或关节镜手术修复创伤性复发性肩关节前脱位是否能带来更好的疗效。
荟萃分析。
检索涉及1966年至2003年10月31日MEDLINE数据库中所有语言的临床研究。使用了以下关键词：（1）肩关节前脱位；（2）Bankart损伤；（3）创伤性复发性肩关节前脱位；（4）关节镜下和开放性Bankart修复术。对所有摘要进行了审查，若存在关节镜手术与开放性手术修复创伤性复发性肩关节前脱位的直接临床比较，则纳入相关文章。对这些文章进行手动交叉引用以获取更多摘要。对最终的文章组进行独立严格评估，并提取以下结果：复发性脱位、恢复活动情况、再次手术率和复发原因。
搜索词分别产生了677、183、68和51条命中记录。其中，18篇文章被确定符合全面审查的条件，包括2篇外语文章。交叉引用发现了2项未发表的研究。最终分析纳入了11项研究：1项随机试验、2项准实验设计、4项前瞻性队列研究、3项回顾性研究和1项病例对照研究。开放性修复组复发性脱位和恢复活动的合并Mantel-Haenszel优势比分别为2.04（P = .003；95%置信区间，1.27，3.29）和2.85（P = .004；95%置信区间，1.40，5.78）。
基于这项荟萃分析，开放性修复在复发率和恢复活动方面具有更有利的结果。
III级，III级（及II/I级）研究的系统评价。
