San Antonio Military Medical Center, San Antonio, Texas, U.S.A..
University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, U.S.A.
Arthroscopy. 2022 Feb;38(2):551-563.e5. doi: 10.1016/j.arthro.2021.07.018. Epub 2021 Jul 29.
To determine whether posterior glenoid bone block augmentation performed for the treatment of recurrent posterior shoulder instability succeeds in restoring stability and is associated with rates of complications or clinical failures comparable to other glenoid bone augmentation procedures.
A comprehensive search of PubMed, MEDLINE, and EMBASE databases was performed. Level of evidence studies I to IV pertaining to posterior bone block augmentation reporting on outcomes or complications were included. The search was carried out in accordance with the Preferred Reported Items for Systematic Reviews and Meta-analyses guidelines.
Screening of titles, abstracts, and manuscripts with application of inclusion and exclusion criteria yielded 17 full-text articles reporting on 269 shoulders undergoing bone block augmentation. Surgical technique varied between studies with regard to graft type (iliac crest, 13 studies; scapular spine, 2; acromion, 1; distal tibia allograft, 1), graft positioning (medial to 1.5 cm lateral to glenoid surface, equatorial to subequatorial), and open versus arthroscopic technique (open, 10 studies; arthroscopic, 4; both, 3). Four of the 8 studies with pre- and postoperative patient-reported outcomes (PROs) showed significant improvements in these outcomes at final follow-up. The postoperative outcomes ranged from 60 to 90 for Rowe scores (n = 7 studies) and 79 to 90 for Walch-Duplay scores (n = 7 studies). Complications were commonly encountered, with high rates of recurrent instability (0% to 73%) and revision procedures (0% to 67%) across different studies.
Posterior bone block augmentation for recurrent posterior shoulder instability does not reliably yield substantial improvements in PROs, and complications are frequently observed. The substantial heterogeneity across studies and the small number of patients precludes any substantive judgements as to the superiority of one surgical technique over another.
IV, systematic review of level III and IV studies.
确定用于治疗复发性后肩不稳定的后盂肱骨块增强术是否成功地恢复了稳定性，并且与其他盂肱骨增强术相比，并发症或临床失败的发生率相当。
对 PubMed、MEDLINE 和 EMBASE 数据库进行全面检索。纳入了涉及后骨块增强术的 I 至 IV 级证据研究，这些研究报告了结果或并发症。搜索符合系统评价和荟萃分析报告的首选项目指南。
通过标题、摘要和手稿的筛选，并应用纳入和排除标准，得出了 17 篇全文文章，报道了 269 例接受骨块增强术的肩部。研究之间的手术技术因移植物类型（髂嵴，13 项研究；肩胛冈，2 项；肩峰，1 项；胫骨远端同种异体移植物，1 项）、移植物定位（盂肱面内侧 1.5 厘米至外侧、赤道至近赤道）以及开放与关节镜技术（开放，10 项研究；关节镜，4 项；两者均有，3 项）而有所不同。4 项具有术前和术后患者报告结果（PROs）的研究中的 8 项显示，在最终随访时这些结果有显著改善。术后结果范围为 Rowe 评分的 60 至 90（7 项研究）和 Walch-Duplay 评分的 79 至 90（7 项研究）。不同研究中经常出现并发症，复发不稳定率（0%至 73%）和翻修手术率（0%至 67%）均较高。
对于复发性后肩不稳定，后盂肱骨块增强术并不能可靠地改善 PROs，且经常出现并发症。由于研究之间存在很大的异质性，以及患者数量较少，因此无法对一种手术技术优于另一种手术技术做出任何实质性判断。
IV，对 III 级和 IV 级研究的系统评价。
