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首页> 外文期刊>Orthopaedic Journal of Sports Medicine >Outcomes After Revision Anterior Shoulder Stabilization: A Systematic Review
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Outcomes After Revision Anterior Shoulder Stabilization: A Systematic Review

机译：修改后的结果前肩稳定：系统审查

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Background: Primary shoulder stabilization is successful, but there continues to be a risk of recurrence after operative repair, particularly in the young athlete. It is important for surgeons to understand the outcomes after various revision stabilization techniques to best counsel patients and manage expectations. Purpose: To analyze recurrent instability and revision surgery rates in patients who underwent revision anterior glenohumeral stabilization procedures with either arthroscopic repair, open repair, coracoid transfer, free bone block, or capsular reconstruction. Study Design: Systematic review; Level of evidence, 4. Methods: We performed a systematic review of level 2 to 4 evidence studies using PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines. Clinical studies of revision anterior glenohumeral stabilization (arthroscopic repair, open repair, coracoid transfer, free bone block, or capsular reconstruction) with a minimum 2-year follow-up were analyzed. The rate of recurrent instability, rate of revision surgery, patient-reported outcomes, and range of motion were extracted and reported. Study methodological quality was evaluated using the Downs and Black quality assessment score. Results: A total of 37 studies met inclusion criteria and were available for analysis: 20 studies evaluated arthroscopic repair, 8 evaluated open repair, 5 evaluated Latarjet procedure, 3 evaluated bone block, and 2 evaluated capsular reconstruction. There was 1 study included in both arthroscopic and Latarjet procedures, for a total of 1110 revision cases. There was 1 level 2 study, and the remainder were level 3 or 4 with poor Downs and Black scores. Participants analyzed were most commonly young (weighted mean age, 26.1 years) and male (78.4%). The weighted mean clinical follow-up after revision surgery was 47.8 months. The weighted mean rate of recurrent instability was 3.8% (n = 245) after the Latarjet procedure, 13.4% (n = 260) after open repair, 16.0% (n = 531) after arthroscopic repair, 20.8% (n = 72) after bone block, and 31.0% (n = 35) after capsular reconstruction. The weighted mean rate of additional revision surgery was 0.0% after bone block, 0.02% after the Latarjet procedure, 9.0% after arthroscopic repair, 9.3% after open repair, and 22.8% after capsular reconstruction. Patient-reported outcomes and objective measures of range of motion and strength improved with all revision techniques. Conclusion: The current review identifies a deficiency in the literature pertaining to consistent meaningful outcomes and the effect of bone loss after revision shoulder stabilization. Published studies demonstrate, however, that revision shoulder stabilization using arthroscopic, open, coracoid transfer, or bone block techniques yielded satisfactory objective and patient-reported outcomes. The Latarjet procedure exhibited the lowest recurrent instability rate. This study confirms that recurrent instability remains a common problem, despite revision shoulder stabilization. The quality of research in revision shoulder stabilization remains poor, and higher quality studies are needed to establish best practices for treatment of this complex problem.
机译：背景：初级肩部稳定成功，但在手术修复后，尤其是在年轻运动员中的复发存在的风险。对于外科医生来说，在各种修改稳定技术到最佳律师患者和管理期望之后，要了解结果。目的：分析经历前胶质形状稳定手术的患者经常发生的不稳定性和修订手术率，随着关节镜修复，开放修复，吻合骨转移，自由骨块或囊囊重建。研究设计：系统评价;证据级别，4.方法：我们对使用PRISMA的第2级的第2级的系统审查（首选报告项目进行了系统评价和荟萃分析）指导方针进行了系统审查。分析了调节前胶质形状稳定（关节镜修复，开放式修复，色纤维素转移，游离骨块或囊膜重建）的临床研究进行了分析，最低2年随访。提取并报告了复发不稳定，修正率，患者报告的结果和运动范围。使用缩小和黑质评分评分评估研究方法质量。结果：共有37项研究符合纳入标准，可用于分析：20项研究评估关节镜修复，8评价开放式修复，5例评价Latarjet手术，3例评价骨块，2分析囊膜重建。在关节镜和拉拉喷嘴程序中有1项研究，共1110例修订案件。有1级的研究，其余部分是3或4级，较差和黑色分数。分析的参与者最常见的是年轻（加权平均年龄，26.1岁）和男性（78.4％）。修改手术后的加权平均临床随访47.8个月。在Latarjet程序后，复发不稳定性的加权平均速率为3.8％（n = 245），接通修复后的13.4％（n = 260），关节镜修复后16.0％（n = 531），后20.8％（n = 72）荚膜重建后骨块，31.0％（n = 35）。额外的修正手术的加权平均速率为0.0％，在骨块后0.02％，关节镜修复后9.0％，开放后的9.3％，胶囊重建后22.8％。患者报告的结果和客观措施的运动范围和力量改善了所有修订技术。结论：目前的审查确定了与一致有意义的结果有关的文献的缺陷和修改后肩部稳定后的骨质损失的影响。然而，已发表的研究证明，使用关节镜，开放，吻合转移或骨块技术的修正肩稳定产生令人满意的物镜和患者报告的结果。 Latarjet程序表现出最低的经常性不稳定率。本研究证实，尽管肩部稳定，但仍然存在反复不稳定仍然是一个常见问题。修订肩部稳定的研究质量仍然差，需要更高的质量研究来建立治疗这种复杂问题的最佳实践。

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