目的

本研究旨在比较不同手术方法治疗肩关节前部不稳定（anterior shoulder instability，ASI）伴关节盂骨缺损（glenoid bone loss，GBL）的临床疗效和安全性，为临床提供参考。

方法

检索PubMed、Scopus、Embase、Cochrane Library 和Web of Science 数据库中与ASI 手术治疗相关的随机对照试验、病例对照研究和队列研究。根据纳入标准和排除标准对文献进行筛选，最后纳入关节镜下Bankart 修复（arthroscopic Bankart repair，AB）、关节镜下Latarjet（arthroscopic Laterjet，AL）、 切开Latarjet（open Laterjet，OL）、AB 联合Remplissage（arthroscopic Bankart repair combined with Remplissage，ABR）和游离骨块（free bone block，FBB）移植共5 种手术方式。采用Stata 17.0 软件进行频率学派网状Meta 分析，以比较不同手术方式治疗ASI 伴GBL 的临床疗效。

结果

共纳入22 项临床研究（包含2 073 例患者）进行系统评价和网状Meta 分析。在复发率方面，与AB 组相比，AL 组（OR=0.24，95% CI：0.08～0.71）、OL 组（OR=0.30，95% CI：0.16～0.59）具有显著更低的复发率；在≥15% GBL 的手术治疗中，OL 组（OR=0.22，95% CI：0.08～0.63）复发率同样显著低于AB 组。在再次手术率方面，与AB 组相比，AL 组（OR=0.13，95% CI：0.02～0.92）、OL 组（OR=0.16，95% CI：0.04～0.63）具有显著更低的再次手术率。在Rowe 评分方面，≥15%GBL 的手术治疗中，与AB 组、OL 组和AL 组相比，FBB 组具有显著更高的Rowe 评分。在并发症方面，与ABR 组相比，FBB 组（OR=4.31，95% CI：1.19～15.58）具有显著更高的并发症发生率。总体一致性检验、发表偏倚检验均显示结果具有稳定性。

结论

AL、OL 均是治疗ASI 伴GBL 的有效手术治疗方案，但在≥15% GBL 的情况下，OL 具有更低的复发率和再次手术率。FBB 治疗ASI 伴GBL具有最佳的关节功能评分，但同时也具有最高的并发症发生率。

Background

The glenohumeral joint is the most flexible joint with the most extensive range of motion in the human body， capable of completing internal rotation， external rotation， abduction and adduction， etc. However， its anatomical structure also leads to poor stability， increasing the risk of joint instability and dislocation. The stability of the shoulder joint is maintained by static structures such as the glenoid， glenoid lip， and ligaments， as well as dynamic stable structures such as the supraspinatus，infraspinatus， and subscapular muscles. Disruption of static or dynamic stability can cause the humerus head to move beyond its normal range relative to the glenoid， resulting in symptoms of joint instability， such as shoulder pain and weakness. The incidence of shoulder joint instability is the highest among all human joints，of which the anterior instability accounts for more than 95%. Epidemiological studies have shown that the incidence of anterior shoulder instability （ASI） in the general population is about 0.08‰， and the incidence in young high-risk men can be as high as 3%. Shoulder instability can lead to chronic pain， impaired mobility，and glenohumeral arthritis， so restoring joint stability is critical. When shoulder joint anterior dislocation occurs， it often leads to anterior and inferior glenoid labial tear （Bankart injury）， which may be accompanied by glenoid bone loss （GBL）， thus increasing the risk of recurrent dislocation and the difficulty of surgical treatment. Bankart prosthetics are widely used in the treatment of ASI， but long-term clinical follow-up has shown a high recurrence rate， especially in patients with GBL and Hill-Sachs lesions. Therefore， Latarjet，free bone block （FBB）transplantation ， and other procedures have gradually been widely used in the clinic.These surgical methods have different advantages and disadvantages， so comparing their clinical efficacy in treating ASI with GBL is necessary. Although previous studies used mesh meta-analysis to compare various surgical procedures for ASI， patients with GBL could not be compared due to limited research literature.

Objective

To compare the clinical efficacy and safety of various surgical approaches for treating ASI with GBL to provide valuable insights for clinical practice.

Methods

Randomized controlled trials， case-control studies， and cohort studies related to ASI surgery were searched in PubMed， Scopus，Embase， Cochrane Library， and Web of Science databases. The literature was screened according to inclusion criteria and exclusion criteria and finally included arthroscopic Bankart repair （AB）， Arthroscopic Latarjet AL， open Latarjet OL， AB combined with Remplissage and FBB transplantation were used in 5 surgical procedures. Frequency school mesh meta-analysis was performed using Stata 17.0 software to compare the clinical efficacy of different surgical methods for ASI with GBL.

Results

Twenty-two clinical studies （including 2 073 patients） were included for systematic review and mesh meta-analysis. Regarding recurrence rate， the AL group （OR=0.24， 95% CI：0.08-0.71） and OL group （OR=0.30， 95% CI：0.16-0.59）had significantly lower recurrence rates than the AB group. The recurrence rate in the OL group （OR=0.22，95% CI：0.08-0.63） was also significantly lower than that in the AB group for ≥15% GBL. Regarding the reoperation rate， the AL group （OR=0.13， 95% CI：0.02-0.92） and the OL group （OR=0.16， 95% CI：0.04-0.63） had significantly lower reoperation rates than the AB group. Regarding Rowe's score， surgical treatment of ≥15% GBL had a significantly higher Rowe score in the FBB group compared with the AB， OL， and AL groups. Regarding complications， the FBB group （OR=4.31， 95% CI：1.19-15.58） had a significantly higher complication rate than the ABR group. The overall consistency and publication bias tests showed that the results were stable.

Conclusion

AL and OL are both effective surgical treatment options for ASI with GBL， but OL has a lower recurrence rate and reoperation rate when ≥15% GBL. FBB for ASI with GBL had the best joint function score and complication rate.