Worcestershire Acute Hospitals NHS Trust, Worcestershire, United Kingdom.
The Royal Orthopaedic Hospital, Birmingham, United Kingdom.
Arthroscopy. 2024 May;40(5):1637-1654. doi: 10.1016/j.arthro.2023.10.021. Epub 2023 Oct 27.
To compare the 2 Latarjet fixation techniques-screw fixation (SF) versus suture button (SB) -for clinical, biomechanical, and radiologic outcomes.
A systematic review was conducted in accordance with Preferred Reporting Items for Systematic and Meta-Analyses guidelines using MEDLINE and Embase databases and was prospectively registered on PROSPERO. Only comparative clinical and biomechanical studies of Latarjet with SF and SB were included. Studies were appraised using the Methodical Index for Non-Randomised Studies (MINORS) tool.
Eleven studies met eligible criteria: 7 clinical studies (SB, n = 279; SF, n = 845) and 4 biomechanical. In total, 80.9% (SB) and 84.2% (SF) of patients were male. Follow-up ranged from 6 to 63.6 months. The overall recurrent instability rate for SB ranged from 0 to 8.3% and for SF ranged from 0 to 2.75%. Only one study demonstrated a greater recurrent instability rate with SB (P = .02). Overall SB complication rates ranged from 0 to 12.5% and SF ranged from 0 to 27%. Two studies reported greater complications and reoperations with SF related to hardware. Summary forest plots from 4 studies showed no significant difference in Walch Duplay score (mean difference, range -5.00 to 1.20 [95% confidence interval {CI} -12.13 to 8.56], I inconsistency = 0%), Rowe score (mean difference, range -2.00 to 4.00 [95% CI -7.37 to 7.66], I inconsistency = 45%), and VAS for pain (mean difference, range -0.10 to 0.60 [95% CI -0.72 to 1.33], I inconsistency = 0%). There was no statistically significant difference between SB and SF in the postoperative range of motion. Radiologically, there was no significant difference in graft positioning and union at final follow-up, but graft resorption was greater in SF (range 25.2%-47.6%) compared with SB (range 10.1%-18.5%). Biomechanical studies showed no significant difference in maximum load to failure (SB, range 184-266 N vs SF, range 148-288 N).
Clinically, SB fixation demonstrated similar functional outcome and range of motion when compared with SF, with the potential benefit of lower rates of graft resorption and hardware-related complications. Biomechanically there was no difference in maximum load to failure.
Level III, systematic review of Level III and biomechanical studies.
比较两种 Latarjet 固定技术——螺钉固定（SF）与缝线纽扣（SB）——在临床、生物力学和影像学方面的结果。
按照系统评价和荟萃分析的首选报告项目（PRISMA）指南，对 MEDLINE 和 Embase 数据库进行系统评价，并前瞻性地在 PROSPERO 上进行注册。仅纳入了比较 Latarjet 手术中 SF 和 SB 的临床和生物力学研究。使用非随机研究方法学指数（MINORS）工具对研究进行评估。
符合入选标准的研究有 11 项：7 项临床研究（SB，n=279；SF，n=845）和 4 项生物力学研究。总共 80.9%（SB）和 84.2%（SF）的患者为男性。随访时间为 6 至 63.6 个月。SB 的总体复发性不稳定率为 0 至 8.3%，SF 的复发性不稳定率为 0 至 2.75%。只有一项研究表明 SB 的复发性不稳定率更高（P=0.02）。SB 的总体并发症发生率为 0 至 12.5%，SF 的并发症发生率为 0 至 27%。两项研究报告 SF 与硬件相关的并发症和再次手术更多。4 项研究的汇总森林图显示，Walch Duplay 评分（平均差异，范围 -5.00 至 1.20[95%置信区间（CI）-12.13 至 8.56]，I 不一致性为 0%）、Rowe 评分（平均差异，范围 -2.00 至 4.00[95%CI -7.37 至 7.66]，I 不一致性为 45%）和疼痛视觉模拟评分（VAS）（平均差异，范围 0.10 至 0.60[95%CI -0.72 至 1.33]，I 不一致性为 0%）无显著差异。SB 和 SF 在术后活动范围方面无统计学差异。影像学方面，在最终随访时，移植物的位置和愈合无显著差异，但 SF 组（范围 25.2%-47.6%）的移植物吸收较 SB 组（范围 10.1%-18.5%）更为明显。生物力学研究显示，最大失效载荷无显著差异（SB，范围 184-266 N 与 SF，范围 148-288 N）。
在临床方面，与 SF 相比，SB 固定具有相似的功能结果和活动范围，并且具有较低的移植物吸收和与硬件相关的并发症的潜在优势。在生物力学方面，最大失效载荷无差异。
III 级，III 级和生物力学研究的系统评价。
