翻修性肩关节前路稳定术后的重返运动：一项系统评价
Return to Play After Revision Anterior Shoulder Stabilization: A Systematic Review.
作者信息
Lau Brian C, Pineda Lorena Bejarano, Johnston Tyler R, Gregory Bonnie P, Wu Mark, Fletcher Amanda N, Ledbetter Leila, Riboh Jonathan C
机构信息
Duke Sports Science Institute, Department of Orthopaedic Surgery, Duke University Medical Center, Durham, North Carolina, USA.
Division of Sports Medicine, Department of Orthopaedic Surgery, University of California, Irvine Medical Center, Irvine, California, USA.
出版信息
Orthop J Sports Med. 2021 Mar 4;9(3):2325967120982059. doi: 10.1177/2325967120982059. eCollection 2021 Mar.
BACKGROUND
Revision shoulder stabilizations are becoming increasingly common. Returning to play after revision shoulder stabilizations is important to patients.
PURPOSE
To evaluate the return-to-play rate after revision anterior shoulder stabilization using arthroscopic, open, coracoid transfer, or free bone block procedures.
STUDY DESIGN
Systematic review; Level of evidence, 4.
METHODS
All English-language studies published between 2000 and 2020 that reported on return to play after revision anterior shoulder stabilization were reviewed. Clinical outcomes that were evaluated included rate of overall return to play, level of return to play, and time to return to play. Study quality was evaluated using the Downs and Black quality assessment score.
RESULTS
Eighteen studies (1 level 2; 17 level 4; mean Downs and Black score, 10.1/31) on revision anterior shoulder stabilization reported on return to play and met inclusion criteria (7 arthroscopic, 5 open, 3 Latarjet, and 3 bony augmentation), with a total of 564 revision cases (mean age, 27.9 years; 84.1% male). The weighted mean length of follow-up was 52.5 months. The overall weighted rate of return to play was 80.1%. The weighted mean rate of return to play was 84.0% (n = 153) after arthroscopic revision, 91.5% (n = 153) after open revision, 88.1% (n = 149) after Latarjet, and 73.8% (n = 65) after bone augmentation. The weighted mean rate of return to same level of play was 69.7% for arthroscopic revision, 70.0% for open revision, 67.1% for Latarjet revision, and 61.8% after bone block revision. There were 5 studies that reported on time to return to play, with a weighted mean of 7.75 months (4 arthroscopic) and 5.2 months (1 Latarjet). The weighted mean rates of complication (for studies that provided it) were 3.3% after arthroscopic revision (n = 174), 3.5% after open revision (n = 110), 9.3% after Latarjet revision (n = 108), and 45.8% after bone block revision (n = 72).
CONCLUSION
Revision using open stabilization demonstrated the highest return-to-play rate. Revision using Latarjet had the quickest time to return to play but had higher complication rates. When evaluated for return to same level of play, arthroscopic, open, and Latarjet had similar rates, and bone block had lower rates. The choice of an optimal revision shoulder stabilization technique, however, depends on patient goals. Higher-quality studies are needed to compare treatments regarding return to play after revision shoulder stabilization.
背景
翻修性肩关节稳定手术正变得越来越常见。翻修性肩关节稳定手术后恢复运动对患者很重要。
目的
评估采用关节镜、开放、喙突转移或游离骨块手术进行翻修性前肩关节稳定手术后的运动恢复率。
研究设计
系统评价；证据等级，4级。
方法
回顾了2000年至2020年间发表的所有英文研究，这些研究报告了翻修性前肩关节稳定手术后的运动恢复情况。评估的临床结果包括总体运动恢复率、运动恢复水平和运动恢复时间。使用唐斯和布莱克质量评估评分对研究质量进行评估。
结果
18项关于翻修性前肩关节稳定手术的研究（1项2级；17项4级；唐斯和布莱克平均评分，10.1/31）报告了运动恢复情况并符合纳入标准（7项关节镜手术、5项开放手术、3项拉塔热手术和3项骨增强手术），共有564例翻修病例（平均年龄27.9岁；84.1%为男性）。加权平均随访时间为52.5个月。总体加权运动恢复率为80.1%。关节镜翻修术后加权平均运动恢复率为84.0%（n = 153），开放翻修术后为91.5%（n = 153），拉塔热手术后为88.1%（n = 149），骨增强手术后为73.8%（n = 65）。关节镜翻修、开放翻修、拉塔热翻修和骨块翻修后恢复到相同运动水平的加权平均率分别为69.7%、70.0%、67.1%和61.8%。有5项研究报告了运动恢复时间，加权平均为7.75个月（4项关节镜手术）和5.2个月（1项拉塔热手术）。（提供了该数据的研究中的）加权平均并发症发生率在关节镜翻修术后为3.3%（n = 174），开放翻修术后为3.5%（n = 110），拉塔热翻修术后为9.3%（n = 108），骨块翻修术后为45.8%（n = 72）。
结论
采用开放稳定手术进行翻修的运动恢复率最高。采用拉塔热手术翻修的运动恢复时间最快，但并发症发生率较高。在评估恢复到相同运动水平时，关节镜、开放和拉塔热手术的恢复率相似，而骨块手术的恢复率较低。然而，最佳翻修性肩关节稳定技术的选择取决于患者的目标。需要更高质量的研究来比较翻修性肩关节稳定手术后运动恢复方面的治疗方法。
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