University of Michigan Medical School, University of Michigan, Ann Arbor, Michigan.
Sports Health. 2011 Jul;3(4):396-404. doi: 10.1177/1941738111409175.
It remains unknown if arthroscopic repair of recurrent anterior shoulder instability is as effective as open repair.
The purpose of this study is to analyze the literature to provide clinical recommendations regarding the most appropriate therapeutic intervention for recurrent anterior shoulder instability.
Systematic review of level I and II studies.
PubMed, EMBASE, the Cochrane Database of Systematic Reviews, and secondary references from 1967 to March 2010 were appraised for studies that met the inclusion criteria.
Inclusion criteria were English-language level I or level II trials involving the treatment of recurrent anterior shoulder instability. Exclusion criteria included non-English-language studies; level III, IV, or V studies; and trials examining treatment of first-time shoulder dislocation, posterior shoulder dislocation, or diagnoses other than recurrent anterior shoulder dislocations.
Included studies underwent quality appraisal independently by each author identifying strengths, weaknesses, and biases.
Four randomized controlled trials compared the use of arthroscopic and open repair for recurrent anterior shoulder dislocations. These studies show no statistically significant difference between the 2 operative approaches. No long-term follow-up data describing the effects of either surgical approach are available at this time. Each investigation had weaknesses in study design that decreased the validity of its findings.
While limited, the available evidence from randomized controlled trials does not show a statistically significant difference in redislocation rates, return to activity, and functional outcomes between the arthroscopic and open repair groups. Range of motion is marginally better following arthroscopic treatment when compared with open repair. Recommendations on the optimal surgical intervention cannot be provided.
关节镜下修复复发性肩关节前向不稳定的效果是否与开放性修复相同仍不清楚。
本研究旨在对文献进行分析，为复发性肩关节前向不稳定的最佳治疗干预提供临床建议。
对 I 级和 II 级研究进行系统回顾。
从 1967 年到 2010 年 3 月，评估了符合纳入标准的研究，包括 PubMed、EMBASE、Cochrane 系统评价数据库和二级参考文献。
纳入标准为英语 I 级或 II 级试验，涉及复发性肩关节前向不稳定的治疗。排除标准包括非英语研究；III、IV 或 V 级研究；以及首次肩关节脱位、后向肩关节脱位或诊断为复发性肩关节前脱位以外的其他诊断的试验。
纳入的研究由每位作者独立进行质量评估，确定优势、劣势和偏倚。
四项随机对照试验比较了关节镜和开放性修复复发性肩关节前脱位的效果。这些研究表明两种手术方法之间没有统计学上的显著差异。目前尚无长期随访数据描述这两种手术方法的效果。每一项研究在研究设计上都存在缺陷，降低了其研究结果的有效性。
尽管证据有限，但随机对照试验的现有证据表明，在再脱位率、恢复活动能力和功能结果方面，关节镜和开放性修复组之间没有统计学上的显著差异。与开放性修复相比，关节镜治疗后的活动范围稍好。不能提供关于最佳手术干预的建议。
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