Li Lang, Zeng Bofang, Ding Meng, Wan Sha, Lin Kefu, Tian Zhen
Department of Orthopedics, Hospital of Chengdu Office of People's Government of Tibetan Autonomous Region (Hospital.C.T.), Chengdu, 610041, People's Republic of China.
Department of Rehabilitation, Hospital of Chengdu Office of People's Government of Tibetan Autonomous Region (Hospital.C.T.), Chengdu, 610041, People's Republic of China.
J Orthop Surg Res. 2025 Jan 30;20(1):119. doi: 10.1186/s13018-024-05425-0.
Anterior shoulder instability with glenoid bone loss presents a challenge in orthopedic surgery. The Latarjet and iliac crest bone graft transfer (ICBGT) procedures are commonly employed for its management, but direct comparative evidence is insufficient.
Following PRISMA guidelines, a comprehensive search of PubMed, EMBASE, Cochrane Library, and Web of Science was conducted. Randomized controlled trials (RCTs) and cohort studies directly comparing the Latarjet and ICBGT procedures were included. Primary outcomes included postoperative recurrent instability, apprehension test, and complications, while secondary outcomes comprised Rowe score, Subjective Shoulder Value (SSV), pain level assessed by visual analogue scale (VAS), range of motion (ROM), and radiologic outcomes. Quality assessment was performed using RoB2 and MINORS tools. The weighted mean difference (WMD) for continuous variables and odds ratio (OR) for dichotomous variables were calculated, along with 95% confidence intervals (CIs). Meta-analysis was performed using RevMan 5.4.1 software.
A total of 6 studies with 409 patients were included. There was no significant difference in postoperative recurrent instability (OR, 1.33; 95% CI, 0.44 to 4.03; P = 0.61), positive apprehension test (OR, 0.78; 95% CI, 0.20 to 3.10; P = 0.73), revision surgery (OR, 2.06; 95% CI, 0.74 to 5.71; P = 0.16), mild complications (OR, 0.49; 95% CI, 0.23 to 1.06; 0.07), SSV (WMD, -1.94; 95% CI, -3.94 to 0.06; P = 0.06) or VAS score (WMD, 0.15; 95% CI, -0.17 to 0.47; P = 0.36) between the two procedures. The ICBGT group exhibited statistically superior Rowe scores (WMD, -3.10; 95% CI, -5.10 to -1.10; P = 0.002), as well as improved external (WMD, -5.32; 95% CI, -7.30 to -3.30; P < 0.001) and internal rotation (WMD, -5.11; 95% CI, -6.76 to -3.45; P < 0.001). However, these differences did not surpass the minimal clinically important difference (MCID). Radiological evaluations showed that the ICBGT procedure had statistically better outcomes in immediate glenoid augmentation, preservation and reduced fatty degeneration of the subscapularis (SSC) tendon, and graft remodeling at short-term follow-up.
The ICBGT procedure showed statistically superior Rowe scores and range of motion, but these differences may not be clinically significant. Both procedures had comparable outcomes in recurrent instability, apprehension test results, revision surgery, mild complications, SSV, and pain levels. ICBGT appears to offer advantages in glenoid augmentation and SSC preservation at short-term follow-up.
CRD42024586157.
伴有肩胛盂骨缺损的前肩不稳给骨科手术带来了挑战。Latarjet手术和髂嵴骨移植转移术（ICBGT）常用于其治疗，但直接的对比证据不足。
按照PRISMA指南，对PubMed、EMBASE、Cochrane图书馆和Web of Science进行了全面检索。纳入直接比较Latarjet手术和ICBGT手术的随机对照试验（RCT）和队列研究。主要结局包括术后复发性不稳、恐惧试验和并发症，次要结局包括Rowe评分、主观肩关节评价值（SSV）、视觉模拟量表（VAS）评估的疼痛程度、活动范围（ROM）和影像学结局。使用RoB2和MINORS工具进行质量评估。计算连续变量的加权平均差（WMD）和二分变量的比值比（OR），以及95%置信区间（CI）。使用RevMan 5.4.1软件进行荟萃分析。
共纳入6项研究，409例患者。两种手术在术后复发性不稳（OR，1.33；95%CI，0.44至4.03；P = 0.61）、阳性恐惧试验（OR，0.78；95%CI，0.20至3.10；P = 0.73）、翻修手术（OR，2.06；95%CI，0.74至5.71；P = 0.16）、轻度并发症（OR，0.49；95%CI，0.23至1.06；P = 0.07）、SSV（WMD，-1.94；95%CI，-3.94至0.06；P = 0.06）或VAS评分（WMD，0.15；95%CI，-0.17至0.47；P = 0.36）方面无显著差异。ICBGT组在Rowe评分（WMD，-3.10；95%CI，-5.10至-1.10；P = 0.002）、外旋（WMD，-5.32；95%CI，-7.30至-3.30；P < 0.001）和内旋（WMD，-5.11；95%CI，-6.76至-3.45；P < 0.001）方面在统计学上表现更优。然而，这些差异未超过最小临床重要差异（MCID）。影像学评估显示，ICBGT手术在即刻肩胛盂增大、肩胛下肌腱（SSC）的保留和脂肪变性减少以及短期随访时移植物重塑方面在统计学上有更好的结局。
ICBGT手术在统计学上显示出更优的Rowe评分和活动范围，但这些差异可能在临床上并不显著。两种手术在复发性不稳、恐惧试验结果、翻修手术、轻度并发症、SSV和疼痛程度方面有可比的结局。ICBGT在短期随访时在肩胛盂增大和SSC保留方面似乎具有优势。
PROSPERO注册号：CRD42024586157。
