背景:Latarjet程序(LP)作为主要稳定程序(主要LP)和早期肩部稳定程序失败时的抢救程序(抢救LP)进行。然而,原发性LP或挽救性LP对肩关节前不稳定是否有较好的疗效尚不清楚.
方法:两名独立的审稿人根据PRISMA指南进行了文献检索。全面搜索PubMed,Embase,WebofScience和CochraneLibrary从成立之日起至2023年12月4日。纳入标准主要包括原发性LP和抢救LP的术后结局比较,英语语言,和全文可用性。两名审稿人独立审查了文献,收集的数据,并评价了纳入研究的方法学稳健性。非随机研究的方法学指标用于评价非随机研究的质量。经常性的不稳定,并发症,重新操作,回到运动,患者报告的结果,和活动范围进行了评估。使用ManagerV.5.4.1进行了统计评估(Cochrane协作,软件更新,牛津,英国)。
结果:系统综述包括12项研究,940名肩部接受初级LP,631名肩部接受打捞LP。在11项研究中的2项和4项研究中的2项研究中发现了有利于原发性LP的统计学显着差异,涉及复发性不稳定和在受伤前水平恢复到相同的运动(RTS),分别。就视觉模拟量表而言,主观肩值和西安大略省肩关节不稳定指数,4中的2项,3中的1项和3中的1项纳入的研究报告了有利于原发性LP的统计学差异。关于并发症没有注意到差异,重新操作,RTS的时间,Rowe的分数,运动肩成绩评分系统,和向前弯曲。
结论:目前的证据表明,与原发性LP相比,在损伤前的复发不稳定性和RTS发生率方面,抢救LP可能提供较差的术后结局.就并发症而言,初级和抢救LP可能产生相当的疗效。重新操作,RTS的速率,RTS的时间,疼痛,肩关节功能,和运动范围。
■CRD42023492027。
BACKGROUND: The Latarjet procedure (LP) is performed as a primary stabilization procedure (primary LP) and a salvage procedure when an earlier shoulder stabilization procedure has failed (salvage LP). However, whether primary LP or salvage LP provides better outcomes for anterior shoulder instability remains unknown.
METHODS: Two independent reviewers performed the literature search based on the PRISMA guidelines. A comprehensive search of PubMed, Embase, web of science and Cochrane Library was performed from their inception date to December 4, 2023. Inclusion criteria mainly included the comparison of postoperative outcomes between primary and salvage LP, English language, and full text availability. Two reviewers independently examined the literature, collected data, and evaluated the methodological robustness of the included studies. The Methodological Index for Nonrandomized Studies was used to evaluate the quality of nonrandomized studies. Recurrent instability, complications, reoperations, return to sports, patient-reported outcomes, and range of motion were assessed. Statistical evaluations were conducted using Manager V.5.4.1 (The Cochrane Collaboration, Software Update, Oxford, UK).
RESULTS: Twelve studies were included in the systematic
review, with 940 shoulders undergoing primary LP and 631 shoulders undergoing salvage LP. Statistically significant differences in favor of primary LP were found in 2 of the 11 and 2 of 4 included studies in terms of recurrent instability and returning to the same sports (RTS) at preinjury level, respectively. In terms of the visual analog scale, subjective shoulder value and the Western Ontario Shoulder Instability Index, 2 of the 4, 1 of the 3 and 1 of the 3 included studies reported statistically significant differences in favor of primary LP. Differences were not noticed regarding complications, reoperations, the time to RTS, the Rowe score, the Athletic Shoulder Outcome Scoring System, and forward flexion.
CONCLUSIONS: Current evidence suggests that compared with primary LP, salvage LP may provide inferior postoperative outcomes in terms of recurrent instability and the rate of RTS at preinjury level. Primary and salvage LP may yield comparable efficacy in terms of complications, reoperations, the rate of RTS, the time to RTS, pain, shoulder function, and range of motion.
UNASSIGNED: CRD42023492027.