Cerciello Simone, Visonà Enrico, Morris Brent Joseph, Corona Katia
Università degli Studi del Molise, Campobasso, Italy.
, Via Riccardo Zandonai 11, 00135, Rome, Italy.
Knee Surg Sports Traumatol Arthrosc. 2016 Feb;24(2):604-11. doi: 10.1007/s00167-015-3607-7. Epub 2015 Apr 24.
Posterior shoulder dislocation is often associated with bone defects. Surgical treatment is often necessary to address these lesions. The aim of the present systematic review was to analyse the available literature concerning bone block procedures in the treatment of bone deficiencies following posterior dislocation. In addition, the methodology of the articles has been evaluated through the Coleman methodology score.
A systematic review of the literature was performed using the keywords "posterior shoulder instability", "posterior shoulder dislocation", "bone loss", "bone defect", "bone block", and "bone graft" with no limit regarding the year of publication. All English-language articles were evaluated using the Coleman methodology score.
Fifty-four articles were identified, and 13 articles met inclusion criteria. The initial cohort included 208 shoulders, and 182 were reviewed at an average follow-up of 72.7 months (±55.2). The average Coleman score was 57.2 (±8.0). The most lacking domains were the size of study population, the type of study, and the procedure for assessing outcomes. All the articles showed an increase in the outcome scores. Radiographic evaluation revealed degenerative changes such as osteoarthritis and graft lysis in most of the series.
This review confirms the lack of studies with good methodological quality. However, bone grafting is a reliable option since significant improvement in all scores is reported. Although a low incidence of recurrence is generally described, there are concerns that the results may deteriorate over time as evidenced by graft lysis and glenohumeral osteoarthritis in up to one-third of patients.
Systematic review, Level IV.
肩关节后脱位常伴有骨缺损。通常需要手术治疗来处理这些损伤。本系统评价的目的是分析有关骨块植入术治疗后脱位后骨缺损的现有文献。此外，通过科尔曼方法学评分对文章的方法学进行了评估。
使用关键词“肩关节后不稳定”“肩关节后脱位”“骨丢失”“骨缺损”“骨块”和“骨移植”对文献进行系统评价，对发表年份无限制。所有英文文章均使用科尔曼方法学评分进行评估。
共识别出54篇文章，13篇文章符合纳入标准。初始队列包括208例肩关节，平均随访72.7个月（±55.2个月）时对182例进行了复查。科尔曼评分平均为57.2（±8.0）。最缺乏的领域是研究人群规模、研究类型和结果评估程序。所有文章均显示结果评分有所提高。影像学评估显示，大多数系列中存在骨关节炎和植骨溶解等退行性改变。
本评价证实缺乏方法学质量良好的研究。然而，骨移植是一种可靠的选择，因为所有评分均有显著改善。虽然一般报道复发率较低，但令人担忧的是，高达三分之一的患者出现植骨溶解和盂肱关节炎，这表明随着时间的推移结果可能会恶化。
系统评价，四级。
