多种手术方式治疗肩关节前向不稳定伴关节盂骨缺损的网状Meta分析  

Network Meta-analysis of surgical approaches for the treatment of anterior shoulder instability with glenoid bone loss

作　　者：陈天鑫 杨胜平 朱瑜琪[1] 高云 张帅 Chen Tianxin;Yang Shengping;Zhu Yuqi;Gao Yun;Zhang Shuai(Department of Orthopaedics,Eye Hospital,China Academy of Chinese Medical Sciences,Beijing 100040,China;Department of Sports Medicine,Wangjing Hospital of China Academy of Chinese Medical Sciences,Beijing 100102,China)

机构地区：[1]中国中医科学院眼科医院骨科,北京100040 [2]中国中医科学院望京医院运动医学一科,北京100102

出　　处：《中华肩肘外科电子杂志》2024年第4期344-352,共9页Chinese Journal of Shoulder and Elbow(Electronic Edition)

基　　金：中国中医科学院眼科医院高水平中医医院项目(GSP2-03、GSP1-06)。

摘　　要：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2073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

关 键 词：肩关节前向不稳定 关节盂骨缺损 LATARJET 手术 BANKART 修复 游离骨块移植 

分 类 号：R68[医药卫生—骨科学]