Chen Dong, Goldberg Jerome, Herald Jonathan, Critchley Ian, Barmare Arshad
Orthopaedic Department, Goulburn Valley Health, The University of Melbourne, Shepparton, VIC, 3630, Australia.
Prince of Wales Hospital, University of New South Wales, Sydney, NSW, Australia.
Knee Surg Sports Traumatol Arthrosc. 2016 Feb;24(2):630-9. doi: 10.1007/s00167-015-3901-4. Epub 2015 Dec 12.
The purpose of this study was to assess the effectiveness of arthroscopic and open surgical techniques on the treatment of shoulder multidirectional instability.
Literature searches were conducted using the databases MEDLINE, Embase, ClinicalTrials.gov, the Cochrane Library, and the Cochrane Central Register of Controlled Trials. Original articles on the surgical management of multidirectional instability were retrieved against selection criteria. Data were extracted and divided into three groups by surgical technique. Proportion and mean meta-analyses were performed for comparison.
The available evidence was from 35 level IV and 1 level II studies. The recurrent instability rate was 9.9 % (95 % CI 7.3-12.9 %) in open capsular shift (OCS) group and 6.0 % (95 % CI 3.7-8.9 %) in arthroscopic capsular plication (ACP) group, between which no difference was observed. However, thermal capsular shrinkage (TCS) group resulted in a recurrent instability rate of 23.9 % (95 % CI 16.6-32.2 %), significantly higher than the above two groups. OCS and ACP groups revealed low reoperation rates of approximately 5.2 % (95 % CI 2.7-8.5 %) and 4.8 % (95 % CI 2.3-8.0 %), respectively, which are lower than that in TCS group of 16.9 % (95 % CI 12.4-21.8 %). OCS caused more loss of external rotation than ACP, losing 7.0 (95 % CI 3.3-10.6) degrees versus 2 (95 % CI 0.9-2.4) degrees, respectively.
ACP and OCS techniques have similar primary outcomes, but the former causes less post-operative stiffness. It is suggestible to avoid TCS in the treatment of MDI.
Level IV.
本研究旨在评估关节镜手术和开放手术技术治疗肩关节多向不稳的有效性。
通过检索MEDLINE、Embase、ClinicalTrials.gov、Cochrane图书馆以及Cochrane对照试验中央注册库等数据库进行文献检索。根据纳入标准检索有关多向不稳手术治疗的原始文章。提取数据并按手术技术分为三组。进行比例和均值的荟萃分析以作比较。
现有证据来自35项IV级研究和1项II级研究。开放囊袋移位（OCS）组的复发不稳率为9.9%（95%CI 7.3 - 12.9%），关节镜下囊袋折叠（ACP）组为6.0%（95%CI 3.7 - 8.9%），两组间未观察到差异。然而，热囊袋收缩（TCS）组的复发不稳率为23.9%（95%CI 16.6 - 32.2%），显著高于上述两组。OCS组和ACP组的再次手术率较低，分别约为5.2%（95%CI 2.7 - 8.5%）和4.8%（95%CI 2.3 - 8.0%），均低于TCS组的16.9%（95%CI 12.4 - 21.8%）。OCS导致的外旋丧失比ACP更多，分别丧失7.0（95%CI 3.3 - 10.6）度和2（95%CI 0.9 - 2.4）度。
ACP和OCS技术的主要疗效相似，但前者术后僵硬程度较轻。在治疗多向不稳时建议避免使用TCS。
IV级。
