Erickson Brandon J, Chalmers Peter N, Cvetanovich Gregory L, Frank Rachel M, Romeo Anthony A, Harris Joshua D
Midwest Orthopaedics at Rush, Rush University Medical Center, Chicago, IL.
Am J Orthop (Belle Mead NJ). 2016 Jul-Aug;45(5):E290-8.
The purpose of this article is to perform a systematic review and meta-analysis of elbow arthroscopy literature to answer the following questions: "Across the world, what demographic of patients are undergoing elbow arthroscopy, what are the most common indications for elbow arthroscopy, and how good is the evidence?" The authors hypothesized that patients who undergo elbow arthroscopy will be chiefly age <40 years, the most common indication for elbow arthroscopy will be a release/débridement, and the evidence regarding elbow arthroscopy will be poor. Also, no significant differences will exist in elbow arthroscopy publications, subjects, outcomes, and techniques based on continent/country of publication. A systematic review was registered with the International Prospective Register of Ongoing Systematic Reviews (PROSPERO) and performed with Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines using 3 publicly available databases. Therapeutic clinical outcome investigations reporting arthroscopic elbow outcomes with levels of evidence I-IV were eligible for inclusion. All study, subject, and surgical technique demographics were analyzed and compared between continents and countries. Statistics were calculated using 1-way analysis of variance (ANOVA) to compare between continents and Pearson's correlation coefficients to evaluate changes over time. In total, 112 studies were included (3093 subjects; 3168 elbows; 64% male; mean 34.9 ± 14.68 years. Mean 33.4 ± 26.02 months follow-up. Most studies were level IV evidence (94.6%) and had a low Modified Coleman Methodology Score (MCMS) (mean 28.1 ± 8.06). From 1985 through 2013, the number of publications significantly increased with time (P = .004) in all continents. The 3 most common indications for elbow arthroscopy were osteochondritis dissecans (OCD), lateral epicondylitis, and release and débridement. The number of reported cases for the 3 most common indications significantly increased over time but did not differ between regions (P > .05 in all cases). Thirty-two studies (28.6%) reported clinical outcomes, the most common of which was the Mayo Elbow Performance Score, reported in 9.8% of studies. The quantity, but not the quality, of arthroscopic elbow publications has significantly increased over time. Most patients undergo elbow arthroscopy for lateral epicondylitis, OCD, and release and débridement. Pathology and indications do not appear to differ geographically with more men undergoing elbow arthroscopy than women.
本文的目的是对肘关节镜检查的文献进行系统评价和荟萃分析，以回答以下问题：“在全球范围内，接受肘关节镜检查的患者的人口统计学特征是什么，肘关节镜检查最常见的适应证是什么，证据的质量如何？”作者假设，接受肘关节镜检查的患者主要年龄小于40岁，肘关节镜检查最常见的适应证将是松解/清创，并且关于肘关节镜检查的证据质量较差。此外，基于发表的大洲/国家，肘关节镜检查的出版物、受试者、结果和技术方面不存在显著差异。一项系统评价已在国际前瞻性系统评价注册库（PROSPERO）注册，并按照系统评价和荟萃分析的首选报告项目（PRISMA）指南，使用3个公开可用的数据库进行。报告关节镜下肘关节结果且证据水平为I-IV级的治疗性临床结果研究符合纳入标准。对所有研究、受试者和手术技术的人口统计学特征进行了分析，并在各大洲和国家之间进行了比较。使用单因素方差分析（ANOVA）计算统计数据以比较各大洲之间的差异，并使用Pearson相关系数评估随时间的变化。总共纳入了112项研究（3093名受试者；3168个肘关节；64%为男性；平均年龄34.9±14.68岁。平均随访33.4±26.02个月。大多数研究为IV级证据（94.6%），且改良科尔曼方法学评分（MCMS）较低（平均28.1±8.06）。从1985年到2013年，所有大洲的出版物数量均随时间显著增加（P = 0.004）。肘关节镜检查最常见的3个适应证是剥脱性骨软骨炎（OCD）、外侧上髁炎以及松解和清创。3个最常见适应证的报告病例数随时间显著增加，但各地区之间无差异（所有病例P>0.05）。32项研究（28.6%）报告了临床结果，其中最常见的是梅奥肘关节功能评分，在9.8%的研究中报告。关节镜下肘关节出版物的数量随时间显著增加，但质量并未提高。大多数患者因外侧上髁炎、OCD以及松解和清创接受肘关节镜检查。病理学和适应证在地理上似乎没有差异，接受肘关节镜检查的男性多于女性。
