Auckland University of Technology, Auckland, New Zealand.
Health and Rehabilitation Research Institute, Auckland University of Technology, Auckland, New Zealand.
Br J Sports Med. 2016 Sep;50(18):1135-41. doi: 10.1136/bjsports-2015-095149. Epub 2015 Dec 23.
Skeletal maturity and age-related changes in the composition of the glenoid labrum and joint capsule may influence rates of recurrent instability in children. We systematically review risk factors which predispose children to recurrent shoulder instability.
The systematic review-concerned studies published before May 2015. Statistical analysis was undertaken to compare rates of recurrence for each extracted risk factor. Pooled ORs were analysed using random effects meta-analysis.
6 retrospective cohort studies met the inclusion criteria. 8 risk factors were identified across the studies including age, sex, shoulder dominance and injury side, mechanism of injury, state of physis closure, and Hill-Sachs and Bankart lesions. The rate of recurrent instability was 73%. Children aged 14-18 years were 24 times more likely to experience recurrent instability than children aged 13 years and less (93% vs 40%; OR=24.14, 95% CI (3.71 to 156.99), Z=3.33, p=0.001, I(2)=6.83%). There was a non-significant trend indicating males were 3.4 times more likely to experience recurrent instability (OR=3.44, 95% CI (0.98 to 12.06), Z=1.93, p=0.053, I(2)=0%). Analysis of one study found that children with a closed physis are 14 times more likely to experience recurrent instability compared with those with an open physis (OR=14.0, 95% CI (1.46 to 134.25), Z=2.29, p=0.02, I(2)=0%) .
Male children aged 14 years and over had the greatest risk of recurrent shoulder instability following a first-time traumatic anterior shoulder dislocation. This meta-analysis summarises a mix of 6 acceptable and poor quality level III retrospective cohort studies. Further examination of this population with blinded prospective cohort studies will assist clinicians in the appropriate management of first-time traumatic anterior shoulder dislocation.
骨骼成熟度和与年龄相关的肩盂唇和关节囊组成的变化可能影响儿童复发性肩关节不稳定的发生率。我们系统地回顾了导致儿童复发性肩关节不稳定的危险因素。
系统综述-考虑了 2015 年 5 月之前发表的研究。对每个提取的危险因素进行了比较复发率的统计分析。使用随机效应荟萃分析分析了汇总 OR。
6 项回顾性队列研究符合纳入标准。研究中确定了 8 个危险因素，包括年龄、性别、肩优势和损伤侧、损伤机制、骨骺闭合状态以及 Hill-Sachs 和 Bankart 病变。复发性不稳定的发生率为 73%。14-18 岁的儿童比 13 岁以下的儿童发生复发性不稳定的可能性高 24 倍（93%比 40%；OR=24.14，95%CI（3.71 至 156.99），Z=3.33，p=0.001，I(2)=6.83%）。有一个非显著趋势表明，男性发生复发性不稳定的可能性高 3.4 倍（OR=3.44，95%CI（0.98 至 12.06），Z=1.93，p=0.053，I(2)=0%）。对一项研究的分析发现，骺板闭合的儿童发生复发性不稳定的可能性是骺板未闭合的儿童的 14 倍（OR=14.0，95%CI（1.46 至 134.25），Z=2.29，p=0.02，I(2)=0%）。
首次创伤性前肩脱位后，14 岁及以上的男性儿童复发性肩关节不稳定的风险最大。本荟萃分析总结了 6 项可接受的 III 级回顾性队列研究和较差的质量水平。进一步对这一人群进行盲法前瞻性队列研究将有助于临床医生对首次创伤性前肩脱位进行适当的管理。
