Abstract：
Posterior shoulder instability (PSI) is a rare and challenging pathology to manage. The aim of this review was to assess and compare whether open and arthroscopic iliac crest bone graft (ICBG) bone block procedures succeeded in improving functional and clinical outcomes as well as radiological outcomes of union and graft resorption.
We hypothesised that there will be no difference in recurrence rate and functional outcome between open and arthroscopic procedures but there will be a higher complication rate with open bone block procedures.
A systematic review was conducted in accordance with PRISMA guidelines using the online databases MEDLINE and Embase. The review was registered on the PROSPERO database. Studies of open or arthroscopic ICBG bone block procedures reporting patient reported outcome measures, recurrence, complications and progression to osteoarthritis and radiological outcomes of graft union and resorption were selected. Studies were appraised using the Methodical index for non-randomised studies (MINORS) tool.
14 studies satisfied the inclusion criteria; five studies were arthroscopic and nine used open techniques. A total of 183 patients and 201 shoulders were included, mean age was 25 years range (14-75 years). Recurrent instability ranged from 0% to 12.5% for arthroscopic and 0% to 36.4% for open studies. Arthroscopic studies had statistically significant increases in numerous functional outcome scores but there was no evidence for similar improvements in open studies. Osteoarthritis at follow-up ranged from 12.5% to 47% in arthroscopic and 0% to 81.8% for open studies. Arthroscopic complication rate ranged from 6.7% to 75% compared to 0% to 80% for open studies. Majority of complications were metalware related requiring surgical intervention. Partial graft resorption ranged from 7.7-100% after arthroscopic and 4.8-100% after open procedures. High union rates were seen with both open and arthroscopic techniques.
This study highlights a lack of high-level evidence for arthroscopic and open posterior bone block procedures using ICBG to manage PSI. Functional and instability outcome scores showed significant improvement with arthroscopic ICBG bone block procedures however limited evidence was available for open studies. Metalwork related complications requiring revision and radiographic progression to osteoarthritis was high in both arthroscopic and open studies.
IV, systematic review.
We hypothesised that there will be no difference in recurrence rate and functional outcome between open and arthroscopic procedures but there will be a higher complication rate with open bone block procedures.
A systematic review was conducted in accordance with PRISMA guidelines using the online databases MEDLINE and Embase. The review was registered on the PROSPERO database. Studies of open or arthroscopic ICBG bone block procedures reporting patient reported outcome measures, recurrence, complications and progression to osteoarthritis and radiological outcomes of graft union and resorption were selected. Studies were appraised using the Methodical index for non-randomised studies (MINORS) tool.
14 studies satisfied the inclusion criteria; five studies were arthroscopic and nine used open techniques. A total of 183 patients and 201 shoulders were included, mean age was 25 years range (14-75 years). Recurrent instability ranged from 0% to 12.5% for arthroscopic and 0% to 36.4% for open studies. Arthroscopic studies had statistically significant increases in numerous functional outcome scores but there was no evidence for similar improvements in open studies. Osteoarthritis at follow-up ranged from 12.5% to 47% in arthroscopic and 0% to 81.8% for open studies. Arthroscopic complication rate ranged from 6.7% to 75% compared to 0% to 80% for open studies. Majority of complications were metalware related requiring surgical intervention. Partial graft resorption ranged from 7.7-100% after arthroscopic and 4.8-100% after open procedures. High union rates were seen with both open and arthroscopic techniques.
This study highlights a lack of high-level evidence for arthroscopic and open posterior bone block procedures using ICBG to manage PSI. Functional and instability outcome scores showed significant improvement with arthroscopic ICBG bone block procedures however limited evidence was available for open studies. Metalwork related complications requiring revision and radiographic progression to osteoarthritis was high in both arthroscopic and open studies.
IV, systematic review.
摘要：
背景：肩后不稳定（PSI）是一种罕见且具有挑战性的病理。这篇综述的目的是评估和比较开放和关节镜下髂骨植骨（ICBG）骨块手术是否能成功改善功能和临床结果以及放射学结果结合和移植物重吸收。
目的：我们假设开放骨块手术和关节镜手术在复发率和功能预后方面没有差异，但开放骨块手术的并发症发生率更高。
方法：根据PRISMA指南使用在线数据库MEDLINE和Embase进行系统评价。审查已在PROSPERO数据库中注册。开放或关节镜下ICBG骨块程序报告患者报告结果测量的研究，复发,选择了骨性关节炎的并发症和进展以及移植物愈合和再吸收的放射学结果.使用非随机研究方法指数（MINORS）工具对研究进行评估。
结果：14项研究符合纳入标准；5项为关节镜检查，9项为开放技术。共纳入183名患者和201名肩膀,平均年龄为25岁(14~75岁).关节镜的复发性不稳定性范围为0％至12.5％，开放研究为0％至36.4％。关节镜研究在许多功能结果评分中具有统计学上的显着增加，但在开放研究中没有类似改善的证据。关节镜下随访时的骨关节炎为12.5％至47％，开放研究为0％至81.8％。关节镜并发症发生率为6.7％至75％，而开放性研究为0％至80％。大多数并发症与需要手术干预的金属制品有关。部分移植物重吸收范围为关节镜后的7.7％-100％，开放手术后的4.8％-100％。开放和关节镜技术均可观察到较高的愈合率。
结论：本研究强调缺乏使用ICBG进行PSI的关节镜和开放后路骨阻滞手术的高水平证据。关节镜下ICBG骨阻滞手术的功能和不稳定性结果评分显示出显着改善，但开放研究的证据有限。在关节镜和开放研究中，需要翻修和放射学进展为骨关节炎的金属加工相关并发症都很高。
方法：IV，系统回顾。
目的：我们假设开放骨块手术和关节镜手术在复发率和功能预后方面没有差异，但开放骨块手术的并发症发生率更高。
方法：根据PRISMA指南使用在线数据库MEDLINE和Embase进行系统评价。审查已在PROSPERO数据库中注册。开放或关节镜下ICBG骨块程序报告患者报告结果测量的研究，复发,选择了骨性关节炎的并发症和进展以及移植物愈合和再吸收的放射学结果.使用非随机研究方法指数（MINORS）工具对研究进行评估。
结果：14项研究符合纳入标准；5项为关节镜检查，9项为开放技术。共纳入183名患者和201名肩膀,平均年龄为25岁(14~75岁).关节镜的复发性不稳定性范围为0％至12.5％，开放研究为0％至36.4％。关节镜研究在许多功能结果评分中具有统计学上的显着增加，但在开放研究中没有类似改善的证据。关节镜下随访时的骨关节炎为12.5％至47％，开放研究为0％至81.8％。关节镜并发症发生率为6.7％至75％，而开放性研究为0％至80％。大多数并发症与需要手术干预的金属制品有关。部分移植物重吸收范围为关节镜后的7.7％-100％，开放手术后的4.8％-100％。开放和关节镜技术均可观察到较高的愈合率。
结论：本研究强调缺乏使用ICBG进行PSI的关节镜和开放后路骨阻滞手术的高水平证据。关节镜下ICBG骨阻滞手术的功能和不稳定性结果评分显示出显着改善，但开放研究的证据有限。在关节镜和开放研究中，需要翻修和放射学进展为骨关节炎的金属加工相关并发症都很高。
方法：IV，系统回顾。
