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首页> 外文期刊>Arthroscopy: the journal of arthroscopic & related surgery : official publication of the Arthroscopy Association of North America and the International Arthroscopy Association >Remplissage, Humeral Osteochondral Grafts, Weber Osteotomy, and Shoulder Arthroplasty for the Management of Humeral Bone Defects in Shoulder Instability: Systematic Review and Quantitative Synthesis of the Literature
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Remplissage, Humeral Osteochondral Grafts, Weber Osteotomy, and Shoulder Arthroplasty for the Management of Humeral Bone Defects in Shoulder Instability: Systematic Review and Quantitative Synthesis of the Literature

机译：重塑，肱骨骨软骨移植，韦伯截骨术和肩关节置换术治疗肩关节不稳中的肱骨缺损：系统评价和文献的定量综合

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Purpose: The aim of this study was to evaluate clinical outcomes, rate of recurrence, complications, and range of movement after remplissage, Weber osteotomy, humeral allograft reconstruction, shoulder arthroplasty, and hemiarthroplasty in patients with anterior or posterior shoulder instability associated with humeral bone loss. Methods: A systematic review of published studies on the management of dislocation of the shoulder with humeral bony procedures was performed. A comprehensive search of the PubMed, Medline, CINAHL (Cumulative Index to Nursing and Allied Health Literature), Cochrane, Embase, and Google Scholar databases was performed using various combinations of the keywords "shoulder," "dislocation," "treatment," "remplissage," "hemiarthroplasty," "arthroplasty," "allograft," "osteotomy," "bone," "loss," "clinical," "outcome," and "Hill Sachs" since inception of the databases to 2014. The following data were extracted: demographic characteristics, bone defects and other lesions, type of surgery, outcome measurement, range of motion, recurrence of instability, and complications. Results: Twenty-six studies were included, in which 769 shoulders were evaluated. The mean value of the Coleman Methodology Score was 69.2 points. Preoperatively, the most detected injuries were Hill-Sachs and Bankart lesions. Shoulder arthroplasty procedures had the highest rate of postoperative recurrence and the lowest scores for postoperative clinical outcomes. The combination of remplissage and Bankart procedures was associated with a lower rate of recurrence when compared with Bankart repair alone (odds ratio, 0.05; 95% confidence interval, 0.01 to 0.25; P = .0002). A high heterogeneity (I-2 = 85%) across the study results was found. Conclusions: Arthroscopic remplissage is the safest technique for the management of patients with shoulder instability with humeral bone loss. Remplissage-Bankart procedures are associated with a lower rate of recurrence when compared with Bankart repair alone. Weber osteotomy, humeral allograft reconstruction, shoulder arthroplasty, and hemiarthroplasty are characterized by a high rate of recurrence, complications, and poor outcome scores.
机译：目的：本研究的目的是评估肱骨骨前或后肩不稳定的患者重塑，韦伯截骨术，肱骨同种异体重建术，肩关节置换术和半髋置换术后的临床结局，复发率，并发症和运动范围失利。方法：对发表的有关肱骨肱骨脱位治疗肩关节脱位的研究进行系统综述。使用关键字“肩膀”，“脱位”，“治疗”，“”的各种组合对PubMed，Medline，CINAHL（护理和相关健康文献的累积索引），Cochrane，Embase和Google Scholar数据库进行了全面搜索。自数据库建立到2014年，是“仿造术”，“髋关节置换术”，“人工关节置换术”，“同种异体移植术”，“骨切开术”，“骨”，“丢失”，“临床”，“结果”和“ Hill Sachs”。提取数据：人口统计学特征，骨缺损和其他病变，手术类型，结果测量，运动范围，不稳定复发和并发症。结果：共纳入26项研究，评估了769条肩。科尔曼方法论得分的平均值为69.2分。术前发现最多的损伤是希尔-萨克斯（Hill-Sachs）和班卡特（Bankart）损伤。肩关节置换术术后复发率最高，术后临床结果得分最低。与仅使用Bankart修复相比，重复使用重复成形术和Bankart程序可降低复发率（优势比，0.05; 95％置信区间，0.01至0.25; P = .0002）。在整个研究结果中发现了很高的异质性（I-2 = 85％）。结论：关节镜镜检查是治疗肩关节不稳合并肱骨丢失的最安全技术。与仅进行Bankart修复相比，Repmplissage-Bankart程序的复发率较低。韦伯截骨术，同种异体肱骨重建术，肩关节置换术和半髋关节置换术的特点是复发率高，并发症多，预后差。

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