Division of Orthopaedic Surgery, Department of Surgery, University of Toronto, Toronto, Ontario, Canada.
Arthroscopy. 2012 Apr;28(4):565-75. doi: 10.1016/j.arthro.2011.11.012. Epub 2012 Feb 14.
The objective of this systematic review was to determine the efficacy of anatomic Bankart repair in patients with a first-time shoulder dislocation compared with either arthroscopic lavage or traditional sling immobilization.
We searched the Cochrane Central Register of Controlled Trials, Medline, Embase, CINAHL, Web of Science, LILACS, and a clinical trials registry for ongoing and completed randomized or quasi-randomized controlled trials comparing anatomic Bankart repair with either rehabilitation or arthroscopic lavage. Two reviewers selected studies for inclusion, assessed methodologic quality, and extracted data. Pooled analyses were performed by use of a random-effects model, and risk ratio (RR) and 95% confidence intervals (CIs) were computed.
We included 3 randomized trials and 1 quasi-randomized trial comprising 228 patients. Of the included trials, 2 compared anatomic Bankart repair with sling immobilization whereas 2 compared Bankart repair with arthroscopic lavage. A meta-analysis of all 4 trials showed that the rate of recurrent instability was significantly lower among participants undergoing anatomic Bankart repair compared with those undergoing either immobilization or arthroscopic lavage (RR, 0.18; 95% CI, 0.10 to 0.33). Subgroup analysis showed that this effect persisted when Bankart repair was compared with arthroscopic lavage alone (2 studies) (RR, 0.14; 95% CI, 0.06 to 0.31) or sling immobilization alone (2 studies) (RR, 0.26; 95% CI, 0.10 to 0.67). Western Ontario Shoulder Instability scores were better with anatomic Bankart repair compared with either arthroscopic lavage or immobilization (2 studies) (mean difference, -232; 95% CI, -317 to -146).
There is evidence to suggest treatment of young patients with a first-time shoulder dislocation with anatomic Bankart repair with the goal of lowering the rate of recurrent instability over the long-term and improving short-term quality of life.
Level II, systematic review of Level I and II studies.
本系统评价旨在确定初次肩关节脱位患者接受解剖型 Bankart 修复术与关节镜下灌洗或传统吊带固定相比的疗效。
我们检索了 Cochrane 对照试验中心注册库、Medline、Embase、CINAHL、Web of Science、LILACS 和一个临床试验注册库，以查找比较解剖型 Bankart 修复术与康复或关节镜下灌洗的随机或半随机对照试验。两名评审员选择纳入的研究，评估方法学质量，并提取数据。采用随机效应模型进行汇总分析，并计算风险比（RR）和 95%置信区间（CI）。
我们纳入了 3 项随机试验和 1 项半随机试验，共纳入 228 名患者。纳入的试验中，有 2 项比较了解剖型 Bankart 修复术与吊带固定，2 项比较了 Bankart 修复术与关节镜下灌洗。对 4 项试验的汇总分析显示，与接受固定或关节镜下灌洗的患者相比，接受解剖型 Bankart 修复术的患者复发性不稳定的发生率显著降低（RR，0.18；95%CI，0.10 至 0.33）。亚组分析显示，当 Bankart 修复术与单独的关节镜下灌洗（2 项研究）（RR，0.14；95%CI，0.06 至 0.31）或单独的吊带固定（2 项研究）（RR，0.26；95%CI，0.10 至 0.67）比较时，这种效果仍然存在。与关节镜下灌洗或吊带固定相比，解剖型 Bankart 修复术的 Western Ontario 肩不稳定评分更好（2 项研究）（平均差值，-232；95%CI，-317 至-146）。
有证据表明，对于初次肩关节脱位的年轻患者，采用解剖型 Bankart 修复术治疗，可降低长期复发性不稳定的发生率，并改善短期生活质量。
II 级，对 I 级和 II 级研究的系统评价。
