Malahias Michael-Alexander, Fandridis Emmanouil, Chytas Dimitrios, Chronopulos Efstathios, Brilakis Emmanouil, Antonogiannakis Emmanouil
3rd Orthopaedic Department, Hygeia Hospital, Erythrou Stavrou 4, Marousi, 15123, Athens, Greece.
Hand-Upper Limb and Microsurgery Department, Hospital KAT, Athens, Greece.
Eur J Orthop Surg Traumatol. 2019 Jul;29(5):957-966. doi: 10.1007/s00590-019-02398-3. Epub 2019 Mar 7.
To investigate whether arthroscopic Latarjet procedure significantly differs from the open procedure as for the clinical, functional and radiographic outcomes.
Two reviewers independently conducted a systematic search according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses using the MEDLINE/PubMed database and the Cochrane Database of Systematic Reviews. These databases were queried with the terms "shoulder" AND "anterior" AND "instability" AND "Latarjet".
From the 259 initial papers, we finally assessed five clinical studies which were eligible to our inclusion-exclusion criteria. The mean modified Coleman score for methodological deficiencies of the studies was 65.4/100, whereas it ranged from 53/100 to 77/100. The arthroscopic technique illustrated comparable results to the open technique regarding the postoperative recurrence rate. No significant difference was found amongst groups in relation to the postoperative osteoarthritis, infection rates, soft tissue healing, postoperative mean American Shoulder and Elbow Surgeons score, mean Walch-Duplay score, fatty infiltration of the subscapularis muscle and posterior protrusion of the screw. The arthroscopic technique yielded significantly superior results as for the non-union rate of the graft, the total graft osteolysis and graft resorption, the mean Western Ontario Shoulder Instability Index score and the early postoperative pain.
Both the open and the arthroscopic Latarjet procedures led to satisfactory radiographic and clinical outcomes for the treatment of patients with recurrent anterior shoulder instability and significant glenoid bone loss. However, the overall quality of the studies ranged from low to moderate.
Comprehensive and systematic review of level II-III therapeutic studies.
探讨关节镜下Latarjet手术在临床、功能和影像学结果方面与开放手术是否存在显著差异。
两名研究者根据系统评价和Meta分析的首选报告项目，独立使用MEDLINE/PubMed数据库和Cochrane系统评价数据库进行系统检索。使用“肩部”“前方”“不稳定”“Latarjet”等术语对这些数据库进行查询。
从259篇初始论文中，我们最终评估了5项符合纳入-排除标准的临床研究。这些研究方法学缺陷的平均改良科尔曼评分为65.4/100，范围为53/100至77/100。关节镜技术在术后复发率方面与开放技术显示出可比的结果。在术后骨关节炎、感染率、软组织愈合、术后平均美国肩肘外科医师评分、平均瓦尔什-迪普莱评分、肩胛下肌脂肪浸润和螺钉后凸方面，各组之间未发现显著差异。在移植物不愈合率、移植物总骨溶解和吸收、平均西安大略肩不稳定指数评分以及术后早期疼痛方面，关节镜技术产生了显著更好的结果。
开放和关节镜下Latarjet手术在治疗复发性前肩不稳和明显盂骨丢失患者时均产生了令人满意的影像学和临床结果。然而，这些研究的整体质量从中等偏低到中等不等。
II-III级治疗性研究的综合系统评价。
