Division of Sports Medicine, Department of Orthopedic Surgery, Rush Medical College of Rush University, Rush University Medical Center, Chicago, Illinois, U.S.A.
Division of Sports Medicine, Department of Orthopedic Surgery, Rush Medical College of Rush University, Rush University Medical Center, Chicago, Illinois, U.S.A..
Arthroscopy. 2020 Jul;36(7):2010-2021. doi: 10.1016/j.arthro.2020.02.036. Epub 2020 Mar 6.
To perform a systematic review of the literature describing outcomes, surgical procedures, and rates of conversion to arthroplasty after arthroscopic debridement of symptomatic primary glenohumeral osteoarthritis.
The Cochrane Database of Systematic Reviews, Cochrane Central Register of Controlled Trials, PubMed, Embase, and Ovid MEDLINE were queried. Articles without sufficiently detailed descriptions of the debridement procedure, those primarily describing cartilage resurfacing procedures, or those that did not report any postoperative outcomes were excluded. Study design, patient demographic characteristics, operative details, imaging findings, patient-reported outcomes, and rates of conversion to arthroplasty were compiled and reported. Assessment of bias was performed using the Methodological Index for Non-randomized Studies (MINORS) criteria.
A total of 371 patients (382 shoulders) in 8 studies were included. Patient sample sizes ranged from 8 patients (9 shoulders) to 98 patients (107 shoulders), and the samples were predominantly comprised of male patients (range, 57.1%-100%). The mean age and follow-up period ranged from 38 to 59 years and from 13.7 to 46.8 months, respectively. In studies reporting both preoperative and postoperative outcomes, improvements were found in American Shoulder and Elbow Surgeons scores (range, 8.6-22) and visual analog scale scores for pain (range, 0.4-3.8). There was significant heterogeneity (I = 75%) in the rates of conversion to shoulder arthroplasty, which ranged from 4% to 42.4%, with the mean time to conversion ranging from 9 to 56 months. Study heterogeneity improved with subgroup analyses based on minimum duration of follow-up (>2 years) and preoperative radiographic inclusion criteria.
Arthroscopic treatment of glenohumeral osteoarthritis provides improvements in ROM and patient-reported outcomes with minimal complications. Despite variability in procedures and rates of subsequent conversion to arthroplasty, arthroscopic treatment appears to provide symptom relief and functional improvements in carefully selected patients. However, the longevity of improvement remains unclear, with studies including a longer duration of follow-up showing potential regression of symptom relief and increased rates of conversion to arthroplasty.
Level IV, systematic review of Level III and IV studies.
系统评价关节镜下清创术治疗原发性肩肱关节骨关节炎的文献，描述其结局、手术过程及关节成形术转化率。
检索 Cochrane 系统评价数据库、Cochrane 对照试验中心注册库、PubMed、Embase 和 Ovid MEDLINE。排除未详细描述清创术过程、主要描述软骨表面置换术或未报告任何术后结局的文章。编译并报告研究设计、患者人口统计学特征、手术细节、影像学发现、患者报告的结局以及关节成形术转化率。采用非随机研究方法学指数（MINORS）标准评估偏倚。
纳入 8 项研究的 371 例患者（382 个肩关节）。患者样本量从 8 例（9 个肩关节）至 98 例（107 个肩关节）不等，样本主要由男性患者组成（范围为 57.1%-100%）。平均年龄和随访时间分别为 38-59 岁和 13.7-46.8 个月。在报告术前和术后结局的研究中，美国肩肘外科医生评分（范围为 8.6-22）和疼痛视觉模拟评分（范围为 0.4-3.8）均有改善。关节成形术转化率的差异显著（I ² = 75%），范围为 4%-42.4%，平均转化率时间为 9-56 个月。根据最小随访时间（>2 年）和术前放射学纳入标准的亚组分析，研究异质性得到改善。
关节镜治疗肩肱关节炎可改善 ROM 和患者报告的结局，并发症少。尽管手术过程和随后关节成形术转化率存在差异，但关节镜治疗似乎可在精心选择的患者中提供症状缓解和功能改善。然而，改善的持久性尚不清楚，随访时间较长的研究显示出症状缓解的潜在回归和关节成形术转化率的增加。
IV 级，III 级和 IV 级研究的系统评价。
