Deng Zhenhan, Zheng Yizi, Su Jingyue, Chen Siyu, Deng Zhiqin, Zhu Weimin, Li Yusheng, Lu Wei
Department of Sports Medicine, The First Affiliated Hospital of Shenzhen University, Shenzhen Second People's Hospital, Shenzhen, China.
Clinical Medical College, Guangxi University of Chinese Medicine, Nanning, China.
Orthop J Sports Med. 2023 Jun 5;11(5):23259671231174476. doi: 10.1177/23259671231174476. eCollection 2023 May.
The open Latarjet (OL) procedure and arthroscopic Latarjet (AL) procedure are able to treat recurrent anterior shoulder instability (RASI) with high success rates.
To evaluate the clinical efficacy and postoperative revisions and complications between the OL and AL procedures in the treatment of RASI.
Systematic review; Level of evidence, 3.
MEDLINE, Embase, and the Cochrane Library were searched to retrieve and include cohort studies comparing the OL and AL procedures for RASI. Clinical outcomes were compared, and results were reported as odds ratios (ORs) or mean differences (MDs) with 95% CIs.
Eleven clinical trials with 1217 patients were included. There were no differences between the procedures in pain score, Rowe score, Walch-Duplay score, external rotation, persistent apprehension, instability, recurrence, revisions attributed to recurrent instability, overall complications, wound infection, hematoma, graft complications, screw-related complications, or osteoarthritis. When compared with the OL procedure, the AL procedure had a significantly lower nonunion rate (OR, 9.92; 95% CI, 1.71 to 57.71; = .01); however, the AL procedure had a longer operation time (MD, -24.49; 95% CI, -48.44 to -0.54; = .05), lower Western Ontario Shoulder Instability Index score (MD, 97.27; 95% CI, 21.91 to 172.63; = .01), higher revision rate (OR, 0.39; 95% CI, 0.16 to 0.95; = .04), and greater screw deviation (MD, -6.41; 95% CI, -10.25 to -2.57; = .001).
For most outcome measures, no difference was seen between the OL and AL procedures. The AL procedure had a lower Western Ontario Shoulder Instability Index score and a higher revision rate and appeared to have a significant learning curve. However, the AL procedure resulted in a lower nonunion rate.
开放性拉塔热（OL）手术和关节镜下拉塔热（AL）手术能够成功治疗复发性前肩不稳（RASI）。
评估OL和AL手术治疗RASI的临床疗效、术后翻修情况及并发症。
系统评价；证据等级，3级。
检索MEDLINE、Embase和Cochrane图书馆，以检索并纳入比较OL和AL手术治疗RASI的队列研究。比较临床结局，并将结果报告为比值比（OR）或均数差（MD）及95%可信区间（CI）。
纳入11项临床试验，共1217例患者。两种手术在疼痛评分、罗威评分、瓦尔什-迪普莱评分、外旋、持续性恐惧、不稳、复发、因复发性不稳导致的翻修、总体并发症、伤口感染、血肿、移植物并发症、螺钉相关并发症或骨关节炎方面无差异。与OL手术相比，AL手术的骨不连发生率显著更低（OR，9.92；95%CI，1.71至57.71；P = 0.01）；然而，AL手术的手术时间更长（MD，-24.49；95%CI，-48.44至-0.54；P = 0.05），西安大略肩不稳指数评分更低（MD，97.27；95%CI，21.91至172.63；P = 0.01），翻修率更高（OR，0.39；95%CI，0.16至0.95；P = 0.04），螺钉偏差更大（MD，-6.41；95%CI，-10.25至-2.57；P = 0.001）。
对于大多数结局指标，OL和AL手术之间无差异。AL手术的西安大略肩不稳指数评分更低，翻修率更高，且似乎存在明显的学习曲线。然而，AL手术导致的骨不连发生率更低。
