切开与关节镜下Latarjet手术治疗肩关节前方不稳定疗效的Meta分析

目的通过Meta分析比较切开与关节镜下Latarjet手术治疗肩关节前方不稳定的临床疗效差异。 方法检索包括国内、外1954年1月至2018年1月已发表的临床对照研究。所检索的数据库包括Embase、Pubmed、Central、Cinahl、PQDT（ProQuest Dissertations and Theses）、中国知网、维普、万方、Cochrane Library、CBM （China Biology Medicine）等数据库。中文检索的关键词为切开、开放、关节镜、Latarjet，检索策略为Latarjet并且切开或关节镜或开放。英文检索的关键词为Open、Arthroscopy、Latarjet，检索策略为Latarjet AND Open OR Arthroscopic。提取数据后，采用Review Manager 5.3软件进行数据分析，比较关节镜下与开放式Latarjet手术间的疗效差异。 结果依据以上检索策略，共检索到相关文献887篇，并最终纳入7篇外文文献。通过比较发现，在Latarjet手术治疗肩关节前方不稳定时，开放式组术后Rowe评分优于关节镜下组95% CI, （0.03, 3.25）, P=0.05]，而且开放式组术后骨块移位情况95% CI（0.12, 0.88）, P=0.03]及患者焦虑程度95% CI（0.20, 0.75）, P=0.005]均少于关节镜下组，其差异具有统计学意义。其余结局指标术后Walch-Duplay评分95% CI（-9.57, 10.65）, P=0.92]；术后肩关节活动度95% CI（-2.32, 7.64）, P=0.30]；术中及术后各种并发症发生率95% CI（0.42, 3.39）, P=0.74]、95% CI（0.14, 2.49）, P=0.48]、95% CI（0.77, 14.09）, P=0.11]、95% CI（0.46, 4.89）, P=0.51]、95% CI（0.12， 0.88）, P=0.03]、95% CI（0.12， 7.22）, P=0.94] ；术后复发率95% CI（0.21, 3.56）, P=0.85]；术后视觉模拟评分（visual analogue scale,VAS） 95% CI（-0.25, 2.92）, P=0.10]；手术所需时间95% CI（-70.10, 11.81）, P=0.10]两组间差异均无统计学意义。 结论开放式与关节镜下Latarjet手术治疗肩关节前方不稳定均能取得良好的治疗效果，且并发症及复发率相当。虽然开放式组在术后Rowe评分、术后骨块移位情况和患者焦虑程度三个指标上均优于关节镜下组，但是关节镜手术仍不失为是一种安全可行的治疗选择。

Open versus arthroscopic Latarjet procedure for treatment of anterior shoulder instability: a Meta-analysis

BackgroundTraumatic shoulder instability is one of the common orthopedic diseases, and over 90% of them are anterior instability. Currently, Latarjet procedure is the most popular among various treatment methods for anterior shoulder joint instability, as it has increased the width of glenoid, solved the problem of glenoid bone defect, and prevented the dislocation of the humeral head with Hill-Sachs injury. In recent years, with the continuous advancement of arthroscopic technology, arthroscopic Latarjet procedure has been gradually introduced into clinical practice since 2006, but whether it has the same good effect as open procedure remains controversial. Objective To compare the clinical efficacy between open and arthroscopic Latarjet procedure in the treatment of anterior shoulder instability via Meta-analysis. MethodsThe search included clinical controlled trials published both at home and abroad from January 1954 to January 2018. The databases retrieved included Embase, PubMed, Central, Cinahl, PQDT, China National Knowledge Infrastructure (CNKI) , CQVIP, Wanfang Data, Cochrane Library, CBM, etc. The keywords of Chinese retrievals were Incision, Open, Arthroscopic and Latarjet. The search strategy was Latarjet AND Cut OR Arthroscopic OR Open. The keywords of English retrievals were Open, Arthroscopic and Latarjet. The search strategy was Latarjet AND Open OR Arthroscopic. After extracting the data, it was analyzed using Review Manager 5.3 software to compare the curative efficacy difference between arthroscopic and open Latarjet procedure. ResultsAccording to the above retrieval strategy, a total of 887 related literatures were retrieved, and 7 foreign literatures were finally included. Through the comparison, we found when Latarjet procedure was used for treatment of anterior shoulder instability, Rowe score was better in the open group than that in the arthroscopy group 95% CI (0.03, 3.25) , P=0.05], and the fragment displacement 95% CI (0.12, 0.88) , P=0.03] and patient anxiety 95% CI (0.20, 0.75) , P=0.005] in the open group were less than that in the arthroscopy group. The difference was statistically significant. There was no difference between two groups in the remaining outcome indicators of postoperative Walch-Duplay score 95% CI (-9.57, 10.65) , P=0.92], postoperative ROM of shoulder joint 95% CI (-2.32, 7.64) , P=0.30], intraoperative and postoperative complications 95% CI (0.42, 3.39) , P=0.74]、95% CI (0.14, 2.49) , P=0.48]、95% CI (0.77, 14.09) , P=0.11]、95% CI (0.46, 4.89) , P=0.51]、95% CI (0.12, 0.88) , P=0.03]、95% CI (0.12, 7.22) , P=0.94], postoperative recurrence rate 95% CI (0.21, 3.56) , P=0.85], postoperative VAS score 95% CI (-0.25, 2.92) , P=0.10] and operation time 95% CI (-70.10, 11.81) , P=0.10]. ConclusionOpen and arthroscopic Latarjet surgery for treatment of anterior shoulder instability can all achieve good effect, and the complications and recurrence are comparable. Although the open group was superior to the arthroscopic group in post-operative Rowe score, graft migration and subjective apprehension , arthroscopic surgery was still a safe and feasible treatment option.