Cantrell Colin, Gerlach Erik, Butler Bennet, Sheth Ujash, Tjong Vehniah
Department of Orthopaedic Surgery, Northwestern Feinberg School of Medicine, 676 N. Saint Clair, Suite 1350, Chicago, IL, 60611, United States.
Department of Orthopaedic Surgery, R Adams Cowley Shock Trauma Center, 22 S Greene St, Baltimore, MD, 21201, United States.
J Orthop. 2020 Sep 29;22:442-448. doi: 10.1016/j.jor.2020.09.019. eCollection 2020 Nov-Dec.
The purpose of this study was to systematically review the literature to gain a greater understanding of the role and usage of arthroscopy in removal of retained bullet fragments. Secondarily, we intend to examine the level of evidence and methodologic quality of studies reporting on this topic.
A search of PubMed, MEDLINE, and Cochrane Database of Systematic Reviews was performed using the search terms ("Arthroscopic" OR "Arthroscopy") AND ("Bullet" OR "Gunshot" OR "Ballistic" OR "Removal"). Inclusion criteria included articles published in English reporting on arthroscopic or arthroscopically-assisted bullet removal. Studies lacking sufficient data to separate arthroscopic and open procedures were excluded. Level of evidence, study information (i.e., country, journal, etc.), and patient data was collected from each eligible article. The methodological index for non-randomized studies (MINORS) score were assigned to each article.
A total of 2676 studies were identified in the initial search with 31 studies meeting criteria for inclusion in the study. Twenty-eight of the 31 studies were case reports. The MINORS score averaged 8.8 ± 1.5 (range 5-10) for included studies. Sixty-two patients were identified, the majority (94%) of whom were male with an average age of 36.2 ± 12.3 years. All 62 patients underwent successful arthroscopic bullet removal. One patient was reported to have a complication (compartment syndrome). Outcome measures were underreported in the majority of studies.
Our study found that very little literature exists on the role of arthroscopy in bullet removal. Of this literature, no high-quality studies exist. Based on the limited existing literature, arthroscopy appears to be a safe, reliable alternative to open surgery for bullet removal. Potential benefits of arthroscopic bullet removal exist and warrant further investigation to further define the role of arthroscopy.
Level V.
本研究旨在系统回顾文献，以更深入了解关节镜在取出残留子弹碎片中的作用和应用。其次，我们打算审查关于该主题研究的证据水平和方法学质量。
使用搜索词（“关节镜检查的”或“关节镜检查”）和（“子弹”或“枪击”或“弹道的”或“取出”）在PubMed、MEDLINE和Cochrane系统评价数据库中进行检索。纳入标准包括以英文发表的关于关节镜或关节镜辅助下子弹取出的文章。缺乏足够数据以区分关节镜手术和开放手术的研究被排除。从每篇符合条件的文章中收集证据水平、研究信息（即国家、期刊等）和患者数据。为每篇文章分配非随机研究方法学指数（MINORS）评分。
在初步检索中总共识别出2676项研究，其中31项研究符合纳入本研究的标准。31项研究中的28项为病例报告。纳入研究的MINORS评分平均为8.8±1.5（范围5 - 10）。共识别出62例患者，其中大多数（94%）为男性，平均年龄为36.2±12.3岁。所有62例患者均成功接受了关节镜下子弹取出术。据报道有1例患者出现并发症（骨筋膜室综合征）。大多数研究对结局指标的报告不足。
我们的研究发现，关于关节镜在子弹取出中作用的文献非常少。在这些文献中，没有高质量的研究。基于现有的有限文献，关节镜检查似乎是一种安全、可靠的替代开放手术进行子弹取出的方法。关节镜下子弹取出存在潜在益处，值得进一步研究以进一步明确关节镜的作用。
V级
