Randelli P, Fossati C, Stoppani C, Evola F R, De Girolamo L
2nd Orthopaedic Department, IRCCS Policlinico San Donato, Via Morandi 30, 20097, San Donato Milanese, Milan, Italy.
Dipartimento di Scienze Biomediche per la Salute, Università degli Studi di Milano, Via Mangiagalli 31, 20133, Milan, Italy.
Knee Surg Sports Traumatol Arthrosc. 2016 Feb;24(2):526-32. doi: 10.1007/s00167-015-3978-9. Epub 2016 Jan 8.
The aim of this study was to compare the clinical results between open and arthroscopic Latarjet and perform a cost analysis of the two techniques.
A systematic review of articles present in PubMed and MEDLINE was performed in accordance with PRISMA guidelines. Studies concerning post-operative outcomes following Latarjet procedures for chronic anterior shoulder instability were selected for analysis. The clinical and radiographic results as well as the costs of the open and arthroscopic techniques were evaluated.
Twenty-three articles, describing a total of 1317 shoulders, met the inclusion criteria: 17 studies were related to open Latarjet, and 6 to the arthroscopic technique. Despite the heterogeneity of the evaluation scales, the clinical results seemed very satisfactory for both techniques. We detected a statistically significant difference in the percentage of bone graft healing in favour of the open technique (88.6 vs 77.6 %). Recurrent dislocation was more frequent following open surgery (3.3 % after open surgery vs 0.3 % after arthroscopy), but this finding was biased by the large difference in follow-up duration between the two techniques. The direct costs of the arthroscopic procedure were double in comparison to open surgery (€2335 vs €1040). A lack of data prevented evaluation of indirect costs and, therefore, a cost-effectiveness analysis.
The open and arthroscopic Latarjet techniques showed excellent and comparable clinical results. However, the much higher direct costs of the arthroscopic procedure do not seem, at present, to be justified by a benefit to the patient.
III.
本研究旨在比较开放性与关节镜下Latarjet手术的临床结果，并对这两种技术进行成本分析。
按照PRISMA指南对PubMed和MEDLINE上的文章进行系统综述。选择有关慢性肩关节前向不稳Latarjet手术后结果的研究进行分析。评估开放性和关节镜技术的临床及影像学结果以及成本。
23篇文章共描述了1317例肩部病例，符合纳入标准：17项研究与开放性Latarjet手术相关，6项与关节镜技术相关。尽管评估量表存在异质性，但两种技术的临床结果似乎都非常令人满意。我们发现骨移植愈合百分比存在统计学显著差异，开放性技术更具优势（88.6%对77.6%）。开放性手术后复发性脱位更常见（开放性手术后为3.3%，关节镜检查后为0.3%），但这一发现因两种技术随访时间的巨大差异而存在偏差。关节镜手术的直接成本是开放性手术的两倍（2335欧元对1040欧元）。缺乏数据妨碍了对间接成本的评估，因此无法进行成本效益分析。
开放性和关节镜下Latarjet技术均显示出优异且可比的临床结果。然而，目前关节镜手术高得多的直接成本似乎并未因对患者有益而得到合理证明。
III级
