关节镜和开放治疗复发性肩关节前方不稳的Meta分析

目的系统评价关节镜下和开放手术治疗青壮年复发性肩关节前方不稳定的疗效。方法计算机检索Cochrane图书馆(2011年第6期)、MEDLINE(1966年至2011年6月)、EMBase(1966年至2011年6月)、中国生物医学文献数据库(1979年1月至2011年6月)、PubMed(1966年6月至2011年6月)、万方数据库和维普数据库,手工检索中文骨科期刊的相关文献。收集所有关节镜与开放手术比较治疗青壮年患者(18～55岁)复发性肩关节前方不稳的随机对照试验,筛选出符合纳入标准的文献,对其进行严格的质量评价后应用RevMan5.0软件进行Meta分析。结果共纳入5个随机对照试验,包含278例患者。Meta分析结果显示,术后肩关节Rowe评分(WMD=4.43,95%CI2.27～6.59),关节镜手术治疗组优于开放手术治疗组。但二者在术后肩关节不稳复发(RR=1.31,95%CI0.51～3.34)、术后神经损伤(RR=0.51,95%CI0.11～2.32)、术后再手术(RR=0.49,95%CI0.11～2.27)、术后恢复伤前功能(RR=0.96,95%CI0.80～1.15)等方面比较均无统计学意义。结论与传统开放手术相比,关节镜手术治疗青壮年复发性肩关节前向不稳,术后肩关节Rowe评分具有优势,但术后并发症等方面二者间无明显差异。

Arthroscopic Compared with Open Repairs for Recurrent Anterior Shoulder Instability in Adults:a Systematic Review of Meta-analysis

Objective To compare the therapeutic effects between arthroscopic and open repairs for recurrent anterior shoulder instability in adults.Methods Medline(1966 to June,2011),EMbase(June,1966 to June,2011),Coehrane Library(Issue 6 2011),CBM(up to June,2011),and CNKI(up to June,2011) were searched for randomized controlled trials on arthroscopic and open repairs for recurrent anterior shoulder instability in adult patients(18～55 years),supplemented by hand searching.Meta-analysis was conducted using the Cachrane Collaboration′s RevMan 5.0 software.Results Only 5 randomized controlled trials involving 278 patients met the criteria of the present study.The Meta-analysis revealed that arthroscopic repairs were associated with higher Rowe scores(weight mean difference=4.43,95% confidence interval=2.27 to 6.59)than open methods.For other outcomes,including shoulder recurrent instability or recurrent dislocation(RR=1.31,95%CI 0.51～3.34),nerve injuries(RR=0.51,95%CI 0.11～2.32),re-operation(RR=0.49,95%CI 0.11～2.27) and return to pre-injury level of activity(RR=0.96,95%CI0.80～1.15),there were no statistically significant differences between the two Groups.Conclusion For adult patients with recurrent anterior shoulder instability,arthroscopic approaches resulted in better function as reflected by the Rowe scores,but no statistically significant differences in complications.