孤立性初次 Latarjet 与 Latarjet 翻修术治疗后临床结果、重返运动和并发症：系统评价和荟萃分析。
Clinical outcomes, return to sport, and complications after isolated primary Latarjet versus Latarjet as a revision procedure: A systematic review and meta-analysis.
机构信息
Department of Orthopaedic Surgery, Rush University Medical Center, 1611W Harrison St., 60612 Chicago, IL, USA.
Department of Orthopaedic Surgery, Rush University Medical Center, 1611W Harrison St., 60612 Chicago, IL, USA.
出版信息
Orthop Traumatol Surg Res. 2024 May;110(3):103810. doi: 10.1016/j.otsr.2023.103810. Epub 2023 Dec 28.
BACKGROUND
The purpose of this review was to compare clinical outcomes, return to sport (RTS), and complications in comparative studies examining patients undergoing primary Latarjet procedure versus Latarjet in the revision setting following soft tissue stabilization.
METHODS
A literature search was conducted using PubMed and Scopus databases using Preferred Reporting Items for Systematic Meta-Analyses guidelines. Inclusion criteria consisted of level I to III human clinical studies reporting clinical outcomes (Visual Analogue Pain Scale [VAS]), RTS metrics, and complications in patients following primary versus revision Latarjet procedures. Study quality was assessed using the Methodological Index for Non-Randomized Studies (MINORS) criteria.
RESULTS
A total of seven studies, consisting of 1170 patients (n=1179 shoulders) with a mean age of 26.4 years, consisting of 91.9% males (n=1083/1179 shoulders), were identified. Mean final follow-up was 46.4 (mean range, 7.3-72.2) months. A total of 748 primary and 431 revision Latarjet procedures were analyzed. Complications were reported in 9.6% (range, 0%-24.2%) of patients undergoing primary and 20.2% (range, 0%-40.7%) in patients undergoing revision procedures (p=0.22). There was no significant difference in the RTS rate between patients undergoing primary (87.3%; range, 83.8%-92.1%) versus Latarjet as a revision procedure (78.9%; range, 60%-100%) (p=0.08). Moreover, no significant difference in postoperative VAS was observed in patients undergoing primary versus Latarjet as a revision procedure (p=0.21). Recurrent shoulder subluxation was significantly greater in patients undergoing revision (12.0%; n=31/259 shoulders; range, 0%-20.7%) compared to primary procedures (3.3%; n=27/511 shoulders; range, 0%-9%) (p<0.001).
DISCUSSION
Patients undergoing primary and revision Latarjet demonstrated overall similar rates of complications and return to sport. Of clinical importance, Latarjet as a revision procedure possessed a risk of recurrent subluxation 3.6 times higher than primary Latarjet. While effective, patients should be counseled regarding the differing prognosis between Latarjet as a primary or revision procedure.
LEVEL OF EVIDENCE
III; Systematic review and meta-analysis.
背景
本研究旨在比较初次行 Latarjet 术与初次行 Latarjet 术后行软组织稳定术的翻修患者的临床结果、重返运动（RTS）和并发症。
方法
根据系统评价与荟萃分析 Preferred Reporting Items 的建议，我们使用 PubMed 和 Scopus 数据库进行文献检索。纳入标准为报道初次与翻修 Latarjet 术后患者临床结果（视觉模拟疼痛量表[VAS]）、RTS 指标和并发症的 I 至 III 级人体临床研究。使用非随机研究方法学指数（MINORS）标准评估研究质量。
结果
共纳入 7 项研究，总计 1170 例患者（n=1179 肩），平均年龄 26.4 岁，91.9%为男性（n=1083/1179 肩），平均末次随访时间为 46.4（平均范围，7.3-72.2）个月。共分析 748 例初次 Latarjet 术和 431 例翻修 Latarjet 术。初次 Latarjet 术和翻修 Latarjet 术的并发症发生率分别为 9.6%（范围，0%-24.2%）和 20.2%（范围，0%-40.7%）（p=0.22）。初次 Latarjet 术与翻修 Latarjet 术的 RTS 率无显著差异[初次：87.3%（范围，83.8%-92.1%）；翻修：78.9%（范围，60%-100%）]（p=0.08）。此外，初次 Latarjet 术与翻修 Latarjet 术的术后 VAS 无显著差异（p=0.21）。翻修组的复发性肩关节半脱位发生率显著高于初次 Latarjet 术组[12.0%（n=31/259 肩；范围，0%-20.7%）比 3.3%（n=27/511 肩；范围，0%-9%）]（p<0.001）。
讨论
初次 Latarjet 术与翻修 Latarjet 术患者的并发症和 RTS 发生率总体相似。具有临床意义的是，翻修 Latarjet 术发生复发性半脱位的风险是初次 Latarjet 术的 3.6 倍。虽然有效，但患者应被告知初次 Latarjet 术与翻修 Latarjet 术之间的预后差异。
证据等级
III；系统评价和荟萃分析。
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