Cho Chul-Hyun, Na Sang Soo, Choi Byung-Chan, Kim Du-Han
Department of Orthopedic Surgery, Keimyung University Dongsan Hospital, Keimyung University School of Medicine, Daegu, Republic of Korea.
Am J Sports Med. 2023 Jan;51(1):263-270. doi: 10.1177/03635465211042314. Epub 2021 Oct 11.
In cases of recurrent anterior shoulder instability with a glenoid defect, Latarjet procedures are widely used for stabilization. Although complications with this procedure have been reported, few studies have comprehensively analyzed issues related to the Latarjet procedure.
To identify the overall complication rate of the Latarjet procedure used for anterior shoulder instability and to compare the rate of complications between arthroscopic and open approaches.
Systematic review; Level of evidence, 4.
PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines were followed by using the PubMed, EMBASE, Scopus, and Cochrane Library databases. Data on complications were extracted and classified as intraoperative, postoperative, or instability-related for further analysis. Quality assessments were performed with criteria from the Methodological Index for Nonrandomized Studies (MINORS). A quantitative synthesis of data was conducted to compare the complication rates between arthroscopic and open approaches.
A total of 35 articles were included in this analysis. The MINORS score was 11.89. A total 2560 Latarjet procedures (2532 patients) were included. The overall complication rate was 16.1% (n = 412). The intraoperative complication rate was 3.4% (n = 87) and included a 1.9% (n = 48) incidence of nerve injuries and a 1.0% (n = 25) incidence of iatrogenic fractures. Screw problems, vascular injuries, and conversion arthroscopic to open surgery each occurred at a rate of <1%. The postoperative complication rate was 6.5% (n = 166), and the most common complication was nonunion (1.3%; n = 33). The instability-related complication rate was 6.2% (n = 159) and included a 1.5% (n = 38) rate of redislocation, a 2.9% (n = 75) rate of positive apprehension test, and a 1.0% (n = 26) rate of instability. Overall, 2.6% (n = 66) of patients required an unplanned secondary operation after the initial surgery. The arthroscopic approach was associated with a higher rate of intraoperative complications compared with the open approach (5.0% vs 2.9%; =.020) and a lower rate of instability-related complications (3.1% vs 7.2%; < .001).
The Latarjet procedure for anterior shoulder instability results in an overall complication rate of 16.1% and a reoperation rate of 2.6%. However, serious complications at short-term follow-up appear rare. When the arthroscopic approach was used, the rate of intraoperative complications was higher, although instability-related complications were lower when compared with the open approach.
在伴有肩胛盂缺损的复发性前肩不稳病例中，Latarjet手术被广泛用于稳定治疗。尽管已报道了该手术的并发症，但很少有研究全面分析与Latarjet手术相关的问题。
确定用于前肩不稳的Latarjet手术的总体并发症发生率，并比较关节镜入路和开放入路的并发症发生率。
系统评价；证据等级，4级。
遵循PRISMA（系统评价和Meta分析的首选报告项目）指南，使用PubMed、EMBASE、Scopus和Cochrane图书馆数据库。提取并发症数据并分类为术中、术后或与不稳相关，以便进一步分析。采用非随机研究方法学指数（MINORS）标准进行质量评估。对数据进行定量综合分析，以比较关节镜入路和开放入路的并发症发生率。
本分析共纳入35篇文章。MINORS评分为11.89。共纳入2560例Latarjet手术（2532例患者）。总体并发症发生率为16.1%（n = 412）。术中并发症发生率为3.4%（n = 87），包括1.9%（n = 48）的神经损伤发生率和1.0%（n = 25）的医源性骨折发生率。螺钉问题、血管损伤以及关节镜手术转为开放手术的发生率均<1%。术后并发症发生率为6.5%（n = 166），最常见的并发症是骨不连（1.3%；n = 33）。与不稳相关的并发症发生率为6.2%（n = 159），包括1.5%（n = 38）的再脱位率、2.9%（n = 75）的恐惧试验阳性率和1.0%（n = 26）的不稳率。总体而言，2.6%（n = 66）的患者在初次手术后需要进行计划外的二次手术。与开放入路相比，关节镜入路的术中并发症发生率较高（5.0%对2.9%；P = 0.020），而与不稳相关的并发症发生率较低（3.1%对7.2%；P < 0.001）。
用于前肩不稳的Latarjet手术的总体并发症发生率为16.1%，再次手术率为2.6%。然而，短期随访中严重并发症似乎很少见。当采用关节镜入路时，术中并发症发生率较高，尽管与开放入路相比，与不稳相关的并发症发生率较低。
