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中华肩肘外科电子杂志

中华肩肘外科电子杂志 ›› 2020, Vol. 08 ›› Issue (01) : 51 -61. doi: 10.3877/cma.j.issn.2095-5790.2020.01.009

所属专题： 文献；

论著

切开与关节镜下Latarjet手术治疗肩关节前方不稳定疗效的Meta分析
高阳阳1, 韩鹏飞2, 陈成龙1, 王春芳3, 吕智4, 卫小春4, 李鹏翠4,†()   
  1. 1. 030001　太原，山西医科大学第二临床医学院骨科
    2. 046000　长治医学院附属和平医院骨科
    3. 030001　太原，山西医科大学实验动物中心
    4. 030001　太原，山西医科大学第二医院骨科　骨与软组织损伤修复重点实验室
  • 收稿日期:2019-12-26 出版日期:2020-02-05
  • 通信作者: 李鹏翠
  • 基金资助:
    国家自然科学基金青年基金(81601949); 山西省回国留学人员科研资助项目(2016-118)

Open versus arthroscopic Latarjet procedure for treatment of anterior shoulder instability: a Meta-analysis

Yangyang Gao1, Pengfei Han2, Chenglong Chen1, Chunfang Wang3, Zhi Lyu4, Xiaochun Wei4, Pengcui Li4,†()   

  1. 1. Department of Orthopaedic Surgery, Second Clinical Medical College of Shanxi Medical University, Taiyuan 030001, China
    2. Department of Orthopaedic Surgery, Heping Hospital Affiliated to Changzhi Medical College, Changzhi 046000 , China
    3. Department of Experimental Animal Center, Shanxi Medical University, Taiyuan 030001, China
    4. Department of Orthopaedic Surgery, Second Hospital of Shanxi Medical University, Shanxi Key Laboratory of Bone and Soft Tissue Injury Repair, Taiyuan 030001, China
  • Received:2019-12-26 Published:2020-02-05
  • Corresponding author: Pengcui Li
  • About author:
    Corresponding author: Li Pengcui, Email:
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引用本文：

高阳阳, 韩鹏飞, 陈成龙, 王春芳, 吕智, 卫小春, 李鹏翠. 切开与关节镜下Latarjet手术治疗肩关节前方不稳定疗效的Meta分析[J]. 中华肩肘外科电子杂志, 2020, 08(01): 51-61.

Yangyang Gao, Pengfei Han, Chenglong Chen, Chunfang Wang, Zhi Lyu, Xiaochun Wei, Pengcui Li. Open versus arthroscopic Latarjet procedure for treatment of anterior shoulder instability: a Meta-analysis[J]. Chinese Journal of Shoulder and Elbow(Electronic Edition), 2020, 08(01): 51-61.

目的

通过Meta分析比较切开与关节镜下Latarjet手术治疗肩关节前方不稳定的临床疗效差异。

方法

检索包括国内、外1954年1月至2018年1月已发表的临床对照研究。所检索的数据库包括Embase、Pubmed、Central、Cinahl、PQDT（ProQuest Dissertations and Theses）、中国知网、维普、万方、Cochrane Library、CBM （China Biology Medicine）等数据库。中文检索的关键词为切开、开放、关节镜、Latarjet，检索策略为Latarjet并且切开或关节镜或开放。英文检索的关键词为Open、Arthroscopy、Latarjet，检索策略为Latarjet AND Open OR Arthroscopic。提取数据后，采用Review Manager 5.3软件进行数据分析，比较关节镜下与开放式Latarjet手术间的疗效差异。

结果

依据以上检索策略，共检索到相关文献887篇，并最终纳入7篇外文文献。通过比较发现，在Latarjet手术治疗肩关节前方不稳定时，开放式组术后Rowe评分优于关节镜下组[95% CI, （0.03, 3.25）, P=0.05]，而且开放式组术后骨块移位情况[95% CI（0.12, 0.88）, P=0.03]及患者焦虑程度[95% CI（0.20, 0.75）, P=0.005]均少于关节镜下组，其差异具有统计学意义。其余结局指标术后Walch-Duplay评分[95% CI（-9.57, 10.65）, P=0.92]；术后肩关节活动度[95% CI（-2.32, 7.64）, P=0.30]；术中及术后各种并发症发生率[95% CI（0.42, 3.39）, P=0.74]、[95% CI（0.14, 2.49）, P=0.48]、[95% CI（0.77, 14.09）, P=0.11]、[95% CI（0.46, 4.89）, P=0.51]、[95% CI（0.12， 0.88）, P=0.03]、[95% CI（0.12， 7.22）, P=0.94] ；术后复发率[95% CI（0.21, 3.56）, P=0.85]；术后视觉模拟评分（visual analogue scale,VAS） [95% CI（-0.25, 2.92）, P=0.10]；手术所需时间[95% CI（-70.10, 11.81）, P=0.10]两组间差异均无统计学意义。

结论

开放式与关节镜下Latarjet手术治疗肩关节前方不稳定均能取得良好的治疗效果，且并发症及复发率相当。虽然开放式组在术后Rowe评分、术后骨块移位情况和患者焦虑程度三个指标上均优于关节镜下组，但是关节镜手术仍不失为是一种安全可行的治疗选择。

关键词: Latarjet术, 肩关节前方不稳定, 关节镜, 切开, Meta分析
Background

Traumatic shoulder instability is one of the common orthopedic diseases, and over 90% of them are anterior instability. Currently, Latarjet procedure is the most popular among various treatment methods for anterior shoulder joint instability, as it has increased the width of glenoid, solved the problem of glenoid bone defect, and prevented the dislocation of the humeral head with Hill-Sachs injury. In recent years, with the continuous advancement of arthroscopic technology, arthroscopic Latarjet procedure has been gradually introduced into clinical practice since 2006, but whether it has the same good effect as open procedure remains controversial. Objective To compare the clinical efficacy between open and arthroscopic Latarjet procedure in the treatment of anterior shoulder instability via Meta-analysis.

Methods

The search included clinical controlled trials published both at home and abroad from January 1954 to January 2018. The databases retrieved included Embase, PubMed, Central, Cinahl, PQDT, China National Knowledge Infrastructure (CNKI) , CQVIP, Wanfang Data, Cochrane Library, CBM, etc. The keywords of Chinese retrievals were Incision, Open, Arthroscopic and Latarjet. The search strategy was Latarjet AND Cut OR Arthroscopic OR Open. The keywords of English retrievals were Open, Arthroscopic and Latarjet. The search strategy was Latarjet AND Open OR Arthroscopic. After extracting the data, it was analyzed using Review Manager 5.3 software to compare the curative efficacy difference between arthroscopic and open Latarjet procedure.

Results

According to the above retrieval strategy, a total of 887 related literatures were retrieved, and 7 foreign literatures were finally included. Through the comparison, we found when Latarjet procedure was used for treatment of anterior shoulder instability, Rowe score was better in the open group than that in the arthroscopy group [95% CI (0.03, 3.25) , P=0.05], and the fragment displacement [95% CI (0.12, 0.88) , P=0.03] and patient anxiety [95% CI (0.20, 0.75) , P=0.005] in the open group were less than that in the arthroscopy group. The difference was statistically significant. There was no difference between two groups in the remaining outcome indicators of postoperative Walch-Duplay score [95% CI (-9.57, 10.65) , P=0.92], postoperative ROM of shoulder joint [95% CI (-2.32, 7.64) , P=0.30], intraoperative and postoperative complications [95% CI (0.42, 3.39) , P=0.74]、[95% CI (0.14, 2.49) , P=0.48]、[95% CI (0.77, 14.09) , P=0.11]、[95% CI (0.46, 4.89) , P=0.51]、[95% CI (0.12, 0.88) , P=0.03]、[95% CI (0.12, 7.22) , P=0.94], postoperative recurrence rate [95% CI (0.21, 3.56) , P=0.85], postoperative VAS score [95% CI (-0.25, 2.92) , P=0.10] and operation time [95% CI (-70.10, 11.81) , P=0.10].

Conclusion

Open and arthroscopic Latarjet surgery for treatment of anterior shoulder instability can all achieve good effect, and the complications and recurrence are comparable. Although the open group was superior to the arthroscopic group in post-operative Rowe score, graft migration and subjective apprehension , arthroscopic surgery was still a safe and feasible treatment option.

Key words: Latarjet procedure, Anterior shoulder instability, Arthroscopic, Open, Meta-analysis
图1 Pubmed检索策略
表1 纳入文献研究基本特征表
作者 类型 国家 年份 组别 例数 年龄（岁） 性别（男/女） 病程（月） 结局指标 随访时间（月） 评价（分）
Zhu等[4] 随机对照 中国 2017 O 44 34.8±11.5 32/12 36.6±50.0 （1）（2）（6） >24 6
A 46 32.1±10.3 36/10 45.0±122.0
Kordasiewicz等[5] 回顾性 波兰 2016 O 48 28（18～59） 45/2 49.9（6～180） （1）（2）（3）（4）（5）（6）（7） 54.2 6
A 62 26（16～44） 55/7 57.5（4～228） 23.4
Metais等[6] 随机对照 法国 2016 O 104 27.8（26.0±8.9） - - （1）（2）（3）（4）（6） 27.7±4.1 6
A 222
Nourissat等[7] 随机对照 法国 2016 O 85 - ? - （5） 12 6
A 99
Marion等[8] 随机对照 法国 2016 O 22 27.3±7.5 16/6 - （3）（4）（5）（6）（7） 29.8±4.4 7
A 36 26.7±7.8 29/7 -
Cunningham等[9] 回顾性 瑞士 2015 O 36 26.0±7.6 34/2 9 （1）（2）（3）（4）（6）（7） 6.3±7.0 5
A 28 25.0±9.2 24/4 12 7.0±4.6
Russo等[10] 前瞻性 意大利 2017 O 21 - 43/3 - （3） 12 6
A 25
图2 文献筛选流程图
图3 关节镜下和开放式Latarjet手术治疗肩关节前方不稳定术后肩关节Walch评分的Meta分析
图4 关节镜下和开放式Latarjet手术治疗肩关节前方不稳定术后肩关节Rowe评分的Meta分析
图5 关节镜下和开放式Latarjet手术治疗肩关节前方不稳定术后肩关节活动度的Meta分析
图6 关节镜下和开放式Latarjet手术治疗肩关节前方不稳定术中并发症发生率的Meta分析
图7 关节镜下和开放式Latarjet手术治疗肩关节前方不稳定术后并发症发生率的Meta分析
图8 关节镜下和开放式Latarjet手术治疗肩关节前方不稳定术后血肿形成发生率的Meta分析
图9 关节镜下和开放式Latarjet手术治疗肩关节前方不稳定术后伤口感染发生率的Meta分析
图10 关节镜下和开放式Latarjet手术治疗肩关节前方不稳定术后骨块移位发生率的Meta分析
图11 关节镜下和开放式Latarjet手术治疗肩关节前方不稳定术后骨不连发生率的Meta分析
图12 关节镜下和开放式Latarjet手术治疗肩关节前方不稳定术后复发率的Meta分析
图13 关节镜下和开放式Latarjet手术治疗肩关节前方不稳定术后VAS评分的Meta分析
图14 关节镜下和开放式Latarjet手术治疗肩关节前方不稳定患者焦虑程度的Meta分析
图15 关节镜下和开放式Latarjet手术治疗肩关节前方不稳定手术时间的Meta分析
图16 术后肩关节功能评分（Walch-Duplay评分/ Rowe评分）发表偏倚漏斗图
图17 术后肩关节外旋活动度发表偏倚漏斗图
图18 术后并发症发生率发表偏倚漏斗图
图19 术后复发率发表偏倚漏斗图
图20 术后VAS评分发表偏倚漏斗图
图21 术后患者焦虑程度发表偏倚漏斗图
图22 手术时间发表偏倚漏斗图
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