Malahias Michael-Alexander, Chytas Dimitrios, Raoulis Vasileios, Chronopoulos Efstathios, Brilakis Emmanouil, Antonogiannakis Emmanouil
3rd Orthopaedic Department, Hygeia Hospital, Erythrou Stavrou 4, Marousi, 15123, Athens, Greece.
2nd Orthopaedic Department, School of Medicine, National & Kapodistrian University of Athens, Agias Olgas 3, Nea Ionia, 14233, Athens, Greece.
Sports Med Open. 2020 Feb 11;6(1):12. doi: 10.1186/s40798-020-0240-x.
A number of clinical trials have been published assessing the role of iliac crest bone grafting for the management of recurrent anterior instability with glenoid bone loss in contemporary practice. We therefore performed a systematic review of contemporary literature to examine the effect of iliac crest bone grafting on postoperative outcomes of these patients. Our hypothesis is that contemporary iliac crest bone block techniques are associated with low reoperation and complication rates combined with satisfactory functional results.
The US National Library of Medicine (PubMed/MEDLINE), the Cochrane Database of Systematic Reviews, and EMBASE were searched between January 2008 and December 2019 for relevant publications.
Following the application of the inclusion-exclusion criteria, nine articles were found eligible for our analysis. In total, 261 patients (mean age range, 25.5-37.5 years; mean follow-up range, 20.6-42 months) were included in the studies of the current review. The mean modified Coleman score was 48.6 (range 37-65), indicating an overall low-to-moderate methodological quality. In the short term, the overall all-cause reoperation rate was 6.1%, while the rate of recurrent instability was 4.8%. The graft non-union rate was 2.2%, while the rate of osteolysis, graft fracture, and infection was 0.4%, 0.9%, and 1.7%, respectively. Finally, hardware-related complications, such as screw breakage or symptomatic mechanical irritation around the screw insertion, occurred in 3.9% of the patients.
Iliac crest bone block techniques in contemporary practice are safe and effective in the short-term (< 4 years) follow-up for the management of anterior shoulder instability with substantial glenoid bone deficiency. However, further studies of higher quality and longer follow-up are required to establish the therapeutic value of these techniques as well as to clarify whether there are differences in the outcomes of arthroscopic and open iliac crest bone block procedures.
在当代临床实践中，已有多项临床试验发表，评估了髂嵴植骨在治疗伴有肩胛盂骨缺损的复发性前向不稳中的作用。因此，我们对当代文献进行了系统回顾，以研究髂嵴植骨对这些患者术后结果的影响。我们的假设是，当代髂嵴骨块技术与低再次手术率和并发症发生率相关，同时功能结果令人满意。
于2008年1月至2019年12月期间在美国国立医学图书馆（PubMed/MEDLINE）、Cochrane系统评价数据库和EMBASE中检索相关出版物。
应用纳入排除标准后，发现9篇文章符合我们的分析要求。本综述研究共纳入了261例患者（平均年龄范围为25.5 - 37.5岁；平均随访范围为20.6 - 42个月）。改良Coleman评分的平均值为48.6（范围为37 - 65），表明总体方法学质量为低至中等。短期内，全因再次手术率为6.1%，而复发性不稳率为4.8%。植骨不愈合率为2.2%，骨溶解、植骨骨折和感染率分别为0.4%、0.9%和1.7%。最后，3.9%的患者出现了与硬件相关的并发症，如螺钉断裂或螺钉插入部位有症状性机械刺激。
在当代临床实践中，髂嵴骨块技术在短期（< 4年）随访中对于治疗伴有大量肩胛盂骨缺损的前肩不稳是安全有效的。然而，需要更高质量和更长随访时间的进一步研究来确定这些技术的治疗价值，以及阐明关节镜下和开放髂嵴骨块手术在结果上是否存在差异。
