Garcia Jose Carlos, do Amaral Felipe Machado, Belchior Renan Juhasz, de Carvalho Lucas Queiroz, Markarian Gregory George, Montero Edna Feasson de Souza
NAEON, São Paulo, Brazil.
Chicago Sports Medicine Institute, Chicago, Illinois, USA.
Orthop J Sports Med. 2019 Jan 25;7(1):2325967118820539. doi: 10.1177/2325967118820539. eCollection 2019 Jan.
Coracoid process transfer for the treatment of recurrent glenohumeral dislocations is a safe and reliable procedure; however, there is no consensus as to which is the best method, the Bristow or Latarjet procedure.
To analyze the results of coracoid process transfer for the treatment of recurrent glenohumeral dislocations and to compare the results of this transfer between the Bristow and Latarjet techniques.
Systematic review; Level of evidence, 4.
The databases surveyed for this review included J-STAGE; Cochrane Bone, Joint and Muscle Trauma Group Specialized Register; Cochrane Controlled Register of Trials; MEDLINE; Ovid; Embase; Google Scholar; and CINAHL. Inclusion criteria consisted of (1) studies related to anterior glenohumeral dislocations treated with transfer of the coracoid process to the anterior glenoid rim and (2) studies that could provide data to perform at least 1 meta-analysis or other statistical evaluation. Titles and abstracts were reviewed for inclusion; thereafter, outcomes and the risk of bias were extracted. Statistical analyses were performed according to the nature of the data. When possible, the 95% CI was included.
Of the 779 studies found, 63 were able to provide data assessing 3395 shoulders. There were no randomized, blinded, or double-blinded trials. The recurrence of dislocations was assessed in 41 studies that used the Bristow technique (n = 2346 shoulders; percentage redislocations [mean ± SE], 1.00% ± 0.20%) and 18 studies that used the Latarjet technique (n = 930 shoulders; percentage redislocations, 2.13% ± 0.49%) ( = .04). The mean loss of external rotation was 12.91° for the Bristow procedure (n = 1440 shoulders) and 11.70° for the Latarjet procedure (n = 243 shoulders). The mean quality-of-life outcome scores were as follows for the Bristow and Latarjet procedures, respectively: Rowe score, 92.06 and 89.33; Western Ontario Shoulder Instability Index score, 16.44% and 19.68%; Japanese Orthopaedic Association score, 93.28 and 92.00; and American Shoulder and Elbow Surgeons score, 91.00 and 89.90.
Transferring the coracoid to the anteroinferior border of the glenoid through the subscapularis tendon is effective, regardless of the technique. When comparing the Bristow and Latarjet techniques, the recurrence of dislocations was the only outcome that could undergo a meta-analysis, and it presented a statistically significant difference in favor of the Bristow procedure. All other outcomes presented no clinically significant differences between their effect sizes. More studies presenting better methodology are still needed to achieve more robust conclusions.
喙突转移术用于治疗复发性盂肱关节脱位是一种安全可靠的手术；然而，对于哪种方法是最佳方法，即布里斯托（Bristow）手术还是拉塔热（Latarjet）手术，目前尚无共识。
分析喙突转移术治疗复发性盂肱关节脱位的结果，并比较布里斯托技术和拉塔热技术在该转移术方面的结果。
系统评价；证据级别，4级。
本次评价所检索的数据库包括J-STAGE；Cochrane骨、关节和肌肉创伤组专业注册库；Cochrane对照试验注册库；MEDLINE；Ovid；Embase；谷歌学术；以及护理及健康领域数据库（CINAHL）。纳入标准包括：（1）与通过将喙突转移至关节盂前缘来治疗前向盂肱关节脱位相关的研究；（2）能够提供数据以进行至少一项荟萃分析或其他统计评估的研究。对标题和摘要进行审查以确定是否纳入；此后，提取结果和偏倚风险。根据数据的性质进行统计分析。可能的情况下，纳入95%置信区间。
在检索到的779项研究中，63项能够提供评估3395个肩关节的数据。没有随机、单盲或双盲试验。在41项使用布里斯托技术的研究（n = 2346个肩关节；再脱位百分比[均值±标准误]，1.00% ± 0.20%）和18项使用拉塔热技术的研究（n = 930个肩关节；再脱位百分比，2.13% ± 0.49%）中评估了脱位的复发情况（P = 0.04）。布里斯托手术（n = 1440个肩关节）的平均外旋丧失为12.91°，拉塔热手术（n = 243个肩关节）为11.70°。布里斯托手术和拉塔热手术的平均生活质量结果评分分别如下：罗伊（Rowe）评分，92.06和89.33；西安大略肩不稳定指数评分，16.44%和19.68%；日本骨科协会评分，93.28和92.00；以及美国肩肘外科医师评分，91.00和89.90。
通过肩胛下肌腱将喙突转移至关节盂的前下缘是有效的，无论采用哪种技术。比较布里斯托技术和拉塔热技术时，脱位复发是唯一能够进行荟萃分析的结果，且在统计学上有显著差异，支持布里斯托手术。所有其他结果在效应量方面均无临床显著差异。仍需要更多方法学更好的研究以得出更可靠的结论。
