Department of Orthopedic Surgery, The Second Affiliated Hospital, Zhejiang University School of Medicine, 1511# JiangHong Road, Hangzhou, 310009, China.
Orthopaedics Research Institute of Zhejiang University, Hangzhou, China.
Eur J Med Res. 2023 Jul 27;28(1):260. doi: 10.1186/s40001-023-01160-0.
Shoulder is vulnerable to dislocation owing to its anatomical structure and the increasing popularity of contact sports in young population. The management of first-time anterior shoulder dislocation in this group is still controversial and the prognosis are varied. This review aimed to compare the results of arthroscopic Bankart repair and conservative management for first-time traumatic anterior shoulder dislocation in young active patients.
Databases were searched till November 2021, and comparative studies between arthroscopic Bankart repair and conservative management for first-time traumatic anterior shoulder dislocation in young population were selected. Methodological quality of the studies was assessed according to the Cochrane Back Review Group 12-item scale. Outcome measures included recurrence of instability, return to play, subsequent instability surgery, and shoulder functional scores.
The search returned 12 eligible trials with 786 participants. All the trials were of prospective design. After arthroscopic Bankart repair, patients experienced significantly less re-dislocation (7.5% vs. 53.0%, p < 0.00001, I = 0%), subluxation (3.1% vs. 24.2%, p < 0.0001, I = 0%), positive apprehension test (7.3% vs. 25.8%, p = 0.002, I = 11%), and subsequent surgical treatment for instability (5.6% vs. 37.8%, p < 0.00001, I = 0%) when compared with those underwent conservative management. And more patients returned to play (83.5% vs. 66.0%, p = 0.03, I = 81%) after arthroscopic Bankart repair. Outcomes regarding the functional scores did not reach a significant difference between the two cohorts.
Arthroscopic Bankart repair showed superiority over conservative management in terms of recurrence, return to play, and subsequent instability surgery during the follow-up in young active patients that encountered first episode of dislocation. As long-term prognosis is comparable, an immediate surgical stabilization might not be suitable for everyone.
由于肩部的解剖结构以及年轻人中接触性运动的日益普及，肩部容易脱位。对于这群人的首次前肩脱位的治疗仍然存在争议，预后也各不相同。本综述旨在比较关节镜下 Bankart 修复术和保守治疗对年轻活跃患者首次创伤性前肩脱位的治疗效果。
检索数据库至 2021 年 11 月，选择比较年轻人群中首次创伤性前肩脱位的关节镜下 Bankart 修复术与保守治疗的对照研究。根据 Cochrane 回顾小组的 12 项标准评估研究的方法学质量。主要结果包括不稳定的复发、重返运动、随后的不稳定手术和肩部功能评分。
搜索共返回 12 项符合条件的试验，共 786 名参与者。所有试验均为前瞻性设计。关节镜下 Bankart 修复术后，患者的再脱位率（7.5%比 53.0%，p<0.00001，I=0%）、半脱位率（3.1%比 24.2%，p<0.0001，I=0%）、前抽屉试验阳性率（7.3%比 25.8%，p=0.002，I=11%）和随后的不稳定手术率（5.6%比 37.8%，p<0.00001，I=0%）均显著低于保守治疗组。关节镜下 Bankart 修复术后，更多的患者重返运动（83.5%比 66.0%，p=0.03，I=81%）。两组患者的功能评分结果无显著差异。
在初次脱位的年轻活跃患者中，关节镜下 Bankart 修复术在随访期间的复发、重返运动和随后的不稳定手术方面优于保守治疗。只要长期预后相当，立即进行手术固定可能并不适合所有人。
