Orthopedic Department, Faculty of Medicine, Ain Shams University, Cairo, Egypt.
Orthopedic Department, Faculty of Medicine, Ain Shams University, Cairo, Egypt.
J Shoulder Elbow Surg. 2020 Oct;29(10):2163-2174. doi: 10.1016/j.jse.2020.04.032. Epub 2020 Jun 9.
A large engaging Hill-Sachs lesion (HSL) with subcritical glenoid bone loss (GBL) is approached through either increasing the glenoid arc by the Latarjet procedure or converting the HSL to an extra-articular defect by arthroscopic Bankart repair with remplissage (BRR). Until now, there has been no evidence-based consensus about which of these 2 most appropriate procedures is the better surgical choice. The purpose of this study was to analyze the current literature comparing results of BRR vs. the Latarjet procedure in the treatment of engaging HSLs with subcritical GBL.
A comprehensive review of the PubMed and Cochrane databases was completed for studies that compared the clinical outcomes and complications of BRR vs. the Latarjet procedure with minimum follow-up of 2 years. The outcome measures analyzed included postoperative Rowe score, visual analog scale pain score, postoperative range of motion (ROM), and rates of recurrent instability and other complications.
Overall, 4 articles (level III evidence in 3 and level II in 1) were included from an initial 804 abstracts. The study population consisted of a total of 379 patients, of whom 194 underwent BRR and 185 underwent the Latarjet procedure. There were no unacceptable differences in baseline characteristics between the 2 groups. For the rate of recurrent instability, both groups had comparable risk ratios (RRs) (N = 379; RR, 0.72; 95% confidence interval [CI], 0.37-1.41). The risk of other complications was significantly increased with the Latarjet procedure (by about 7 times) relative to the the BRR procedure (N = 379; RR, 7.37; 95% CI, 2-27). Both groups had comparable postoperative Rowe scores (n = 190; mean difference [MD], -0.9; 95% CI, -3.45 to 1.7) and visual analog scale pain scores (n = 347; MD, -0.2; 95% CI, -0.6 to 0.2). Moreover, both groups had comparable postoperative external rotation ROM (MD, -1.7°; 95% CI, -9.4° to 6°) and internal rotation ROM (MD, 1.95°; 95% CI, -5.35° to 9.25°). There was substantial heterogeneity in the effect of both procedures on postoperative pain and ROM (external rotation and internal rotation).
Both the BRR and Latarjet procedures are effective for the management of engaging HSLs with subcritical GBL and give comparable clinical outcomes. However, given the fewer overall postoperative complications, remplissage may be safer. The results of the included studies were adequately consistent for most analyzed outcomes. However, for the intervention effect on postoperative pain and ROM, there was a small body of evidence, limiting the strength of the reported conclusions.
对于伴有亚临界肩胛盂骨缺损的大而活跃的 Hill-Sachs 病变（HSL），可以通过 Latarjet 手术增加肩胛盂弧或通过关节镜下 Bankart 修复加填充（BRR）将 HSL 转化为关节外缺损来处理。到目前为止，还没有循证共识表明这两种最适当的手术方法中哪一种是更好的手术选择。本研究的目的是分析目前关于 BRR 与 Latarjet 手术治疗伴有亚临界肩胛盂骨缺损的活动性 HSL 的文献。
对 PubMed 和 Cochrane 数据库进行全面综述，以比较 BRR 与 Latarjet 手术治疗伴有亚临界肩胛盂骨缺损的活动性 HSL 的临床结果和并发症，随访时间至少为 2 年。分析的结局指标包括术后 Rowe 评分、视觉模拟评分疼痛评分、术后活动范围（ROM）以及复发性不稳定和其他并发症的发生率。
从最初的 804 篇摘要中，共纳入了 4 篇文章（3 篇为 III 级证据，1 篇为 II 级证据）。研究人群共包括 379 例患者，其中 194 例接受 BRR，185 例接受 Latarjet 手术。两组间基线特征无不可接受差异。对于复发性不稳定的发生率，两组的风险比（RR）相似（N=379；RR，0.72；95%置信区间[CI]，0.37-1.41）。与 BRR 手术相比，Latarjet 手术的其他并发症风险显著增加（约 7 倍）（N=379；RR，7.37；95%CI，2-27）。两组的术后 Rowe 评分（n=190；平均差异[MD]，-0.9；95%CI，-3.45 至 1.7）和视觉模拟评分疼痛评分（n=347；MD，-0.2；95%CI，-0.6 至 0.2）均相似。此外，两组术后外旋 ROM（MD，-1.7°；95%CI，-9.4°至 6°）和内旋 ROM（MD，1.95°；95%CI，-5.35°至 9.25°）均相似。两种手术对术后疼痛和 ROM（外旋和内旋）的影响均存在较大的异质性。
BRR 和 Latarjet 手术均可有效治疗伴有亚临界肩胛盂骨缺损的活动性 HSL，且具有相似的临床疗效。然而，鉴于术后总体并发症较少，填充术可能更安全。纳入研究的结果在大多数分析结果上足够一致。然而，对于术后疼痛和 ROM 的干预效果，证据有限，限制了报告结论的强度。
