相比于翻修 Bankart 修复术，Latarjet 术治疗失败的 Bankart 修复术可提供更好的稳定性和运动功能恢复，但术后疼痛和外旋受限更严重，且并发症更多：系统评价和荟萃分析。
Latarjet procedure for failed Bankart repair provides better stability and return to sports, but worse postoperative pain and external rotation limitations with more complications, compared to revision Bankart repair: a systematic review and meta-analysis.
机构信息
Department of Orthopaedic Surgery, Center for Shoulder and Elbow Surgery, School of Medicine, Konkuk University, 120-1 Neungdong-Ro (Hwayang-Dong), Gwangjin-Gu, Seoul, 143-729, Korea.
出版信息
Knee Surg Sports Traumatol Arthrosc. 2023 Aug;31(8):3541-3558. doi: 10.1007/s00167-023-07410-2. Epub 2023 Apr 10.
PURPOSE
This study aimed to compare the clinical results of revision Bankart repair versus the Latarjet procedure for failed Bankart repair.
METHODS
A literature search was performed in databases, such as Pubmed, Embase, and Scopus Library. The studies were appraised using the Methodological Index for Non-randomized Studies tool. Studies for failed Bankart repair with revision Bankart repair or Latarjet procedure were included. The pain VAS, ROWE score, rate of return to sports and preinjury level of sports, recurrent instability, range of motion, and complications were compared. Additionally, the pain VAS, ROWE score, forward flexion, and external rotation at side were subjected to a meta-analysis.
RESULTS
Twenty-four articles were included in the systematic review. The functional outcomes in terms of the ROWE score, recurrent instability, return to sports, and the preinjury level of sports was better in the Latarjet procedure group than those in the revision Bankart repair group (ROWE score, 91 vs. 86.7; recurrent instability rate, 3.5% vs. 14.4%; return to sports rate, 100% vs. 87.9%; return to preinjury level of sports rate, 89.9% vs. 74.9%; all P < 0.001). However, the results of postoperative pain and the postoperative limitation of external rotation at side were worse in the Latarjet procedure group than those in the revision Bankart repair group (pain VAS, 1.4 vs. 0.8; postoperative external rotation at side, 38° vs. 60°; all P < 0.001). In addition, the majority of the complications occurred in the Latarjet procedure group. In the meta-analysis, the postoperative ROWE score was significantly higher in the Latarjet procedure group than that in the revision Bankart group (revision Bankart repair: 95% CI 88.9-80.9, I = 65.70; Latarjet procedure: 95% CI 95.8-88.1, I = 93.37; P = 0.014). However, the pain VAS, forward flexion, and external rotation at side did not reach the significant level in the meta-analysis.
CONCLUSION
Compared with revision Bankart repair, the Latarjet procedure for failed Bankart repair showed better ROWE scores, stability, and return to sports or preinjury level of sports; however, the postoperative pain and the limitation of external rotation at side were worse with more complications.
IRB NO
KUMC 2022-01-024.
LEVEL OF EVIDENCE
Level IV.
目的
本研究旨在比较Bankart 修复失败后行翻修 Bankart 修复与 Latarjet 手术的临床结果。
方法
在 Pubmed、Embase 和 Scopus 等数据库中进行文献检索。使用非随机研究方法学指数工具对研究进行评估。纳入 Bankart 修复失败后行翻修 Bankart 修复或 Latarjet 手术的研究。比较疼痛视觉模拟评分（VAS）、ROWE 评分、重返运动率和术前运动水平、复发性不稳定、活动范围和并发症。此外，对疼痛 VAS、ROWE 评分、前屈和侧方外旋进行了荟萃分析。
结果
系统评价纳入 24 篇文章。Latarjet 手术组在 ROWE 评分、复发性不稳定、重返运动和术前运动水平方面的功能结果优于翻修 Bankart 修复组（ROWE 评分，91 比 86.7；复发性不稳定率，3.5%比 14.4%；重返运动率，100%比 87.9%；重返术前运动水平率，89.9%比 74.9%；均 P<0.001）。然而，Latarjet 手术组术后疼痛和术后侧方外旋受限的结果较翻修 Bankart 修复组差（疼痛 VAS，1.4 比 0.8；术后侧方外旋，38°比 60°；均 P<0.001）。此外，大多数并发症发生在 Latarjet 手术组。荟萃分析显示，Latarjet 手术组术后 ROWE 评分明显高于翻修 Bankart 组（翻修 Bankart 修复：95%CI 88.9-80.9，I=65.70；Latarjet 手术：95%CI 95.8-88.1，I=93.37；P=0.014）。然而，疼痛 VAS、前屈和侧方外旋在荟萃分析中未达到显著水平。
结论
与翻修 Bankart 修复相比，Bankart 修复失败后行 Latarjet 手术在 ROWE 评分、稳定性和重返运动或术前运动水平方面更优；然而，术后疼痛和侧方外旋受限更严重，且并发症更多。
IRB 编号：KUMC 2022-01-024。
证据水平
IV 级。
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