■肩前不稳定是世界各国普遍存在的问题,指数脱位后复发的风险很高。手术稳定通常用于持续不稳定,特别是在复发风险高的患者中,以最大程度地减少进一步的唇骨损伤和关节盂骨丢失的风险。然而,关于肩关节前不稳定手术治疗的全球地理差异知之甚少.因此,这项研究的目的是评估和系统回顾肩关节前不稳定的手术治疗的区域差异,特别是与软组织手术相比,骨稳定手术的适应症和结果。
■系统评价,根据2020年系统评价和荟萃分析首选报告项目指南,已执行。纳入标准包括评估适应症的I级和II级证据研究,技术,以及2000年1月至2021年9月发表的前肩关节不稳定手术治疗后的结果。符合纳入标准的研究分为四个全球区域(亚洲,欧洲,北美,南美)基于主要研究地点。患者人口统计学,程序细节,患者报告的结果,和并发症(复发率和再手术率)在地区之间进行比较。
■确定了60项(n=60)研究(5480例患者)。86%的患者是男性,平均年龄26.7岁.患者平均年龄没有差异,尽管在所有地区接受骨稳定手术的患者都比接受软组织稳定手术的患者年龄大(P=.0002)。骨与软组织手术组的比例在地区之间没有显着差异。骨稳定程序的适应症差异很大。平均最终随访时间为3.5年。经常性不稳定性为5.0%,各地区没有变化。然而,与骨稳定手术相比,软组织术后复发性不稳定的发生率更高(P=0.017).南美研究在软组织稳定期间使用了较少的锚(P<0.0001),并且报告了与其他地区相比更高的再手术率(P=0.009)。
■肩关节前不稳定手术后的结果报告存在整体差异。骨和软组织手术的比例相似,无论地理区域。与骨稳定程序相比,反复出现的不稳定性不随区域而变化,但在软组织之后发生的频率更高。有许多潜在的医学和非医学因素可能会影响前肩关节不稳定手术治疗的整体变化。
UNASSIGNED: Anterior shoulder
instability is a common problem around the world, with a high risk for recurrence following the index dislocation. Surgical stabilization is commonly indicated for persistent
instability, particularly in patients at high risk for recurrence, to minimize the risk of further labral injury and glenoid bone loss. However, there is little known about global geographic differences in the surgical management of anterior shoulder instability. As such, the purpose of this study was to evaluate and systematically
review regional differences in the surgical treatment of anterior shoulder instability, particularly the indications for and outcomes from bony stabilization procedures compared to soft tissue procedures.
UNASSIGNED: A systematic
review, in accordance with the 2020 Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines, was performed. Inclusion criteria consisted of level I and II evidence studies evaluating indications, techniques, and outcomes following operative management of anterior shoulder instability published from January 2000 to September 2021. Studies meeting inclusion criteria were grouped into four global regions (Asia, Europe, North America, South America) based on primary study location. Patient demographics, procedural details, patient reported outcomes, and complications (recurrence and reoperation rates) were compared between regions.
UNASSIGNED: Sixty (n = 60) studies (5480 patients) were identified. Eighty-six percent of all patients were male, with a mean age of 26.7 years. There was no difference in mean patient age, though patients undergoing bony stabilization procedures were older than those undergoing soft-tissue stabilization procedures (P = .0002) in all regions. The proportion of bony versus soft-tissue procedure groups did not differ significantly among regions. The indications for bony stabilization procedures varied significantly. Mean final follow-up was 3.5 years. Recurrent
instability was 5.0% and did not vary across regions. However, recurrent instability occurred more frequently following soft-tissue compared to bony stabilization procedures (P = .017). South American studies utilized fewer anchors during soft tissue stabilization (P < .0001) and reported a higher reoperation rate compared to other regions (P = .009).
UNASSIGNED: There is global variation in the reporting of outcomes following surgery for anterior shoulder instability. The proportion of bony and soft-tissue procedures is similar, irrespective of geographic region. Recurrent instability does not vary by region but occurs more frequently following soft-tissue compared to bony stabilization procedures. There are a number of potential medical and nonmedical factors that may affect global variation in the surgical treatment of anterior shoulder instability.