Remplissage手术对肩关节Bankart损伤合并Hill-Sachs损伤患者肩关节外旋功能影响的Meta分析

王江涛; 肇刚; 步建立; 张加廷; 张佳; 齐玮; 李春宝; 安明扬; 刘玉杰

doi:10.3969/j.issn.2095-5227.2021.08.009

Remplissage手术对肩关节Bankart损伤合并Hill-Sachs损伤患者肩关节外旋功能影响的Meta分析

Effect of Remplissage procedure on external rotation of shoulder for Bankart injury with Hill-Sachs lesion: A meta-analysis

摘要

摘要:
背景 Remplissage手术可显著降低肩关节Bankart损伤合并Hill-Sachs损伤术后脱位复发率。但该术式对肩关节外旋功能的影响尚无统一意见。
目的系统评价关节镜下Remplissage手术对肩关节Bankart损伤合并Hill-Sachs损伤患者肩关节外旋功能的影响。
方法检索知网、万方、维普、PubMed、Embase、Web of Science数据库2008年5月- 2019年12月发表的与Remplissage手术相关的中英文文献。根据非随机对照实验方法学评价指标(MINORS)进行文献质量评价，分析Remplissage手术对肩关节外旋功能的影响。
结果本研究共纳入文献15篇，其中英文文献10篇(66.7%)，中文文献5篇(33.3%)，证据等级Ⅲ级文献3篇(20%)，Ⅳ级文献12篇(80%)。共纳入673例患者(674肩)，其中Remplissage + Bankart损伤修复术(B+R) 546例(81.1%)，单纯Bankart手术(B) 127例(18.9%)。Meta结果显示，Remplissage + Bankart(B + R)修复术后，肩关节体侧外旋活动受限平均8.6^o(P＜0.0 01)，90^o外展外旋功能较术前无统计学差异(P=0.054)。Remplissage +Bankart损伤修复术(B+R)与单纯Bankart损伤修复术(B)比较，前者肩关节外旋受限稍重，两者外旋受限相差0.74^o，差异无统计学意义(P=0.078)。
结论 Remplissage + Bankart损伤修复术后肩关节外旋功能部分受限，应根据伤情选择手术适应证。

Abstract:
Background The Rempllisage procedure can significantly decrease the recurrence rate of postoperative dislocation in patients with Bankart injury combined Hill-Sachs lesion, but there is no consensus about the effect of this procedure on external rotation of shoulder.
Objective To systematically evaluate the effect of Arthroscopic Rempllisage procedure on external rotation of the shoulder joint for Bankart lesion with Hill-Sachs lesion.
Methods Chinese and English literatures related to the surgery of Remplissage were searched from May 2008 to December 2019 in CNKI, WAN-FANG, CQVIP, PubMed, Embase and Web of Science. Quality assessment for all included clinical studies was performed using the Methodological Index for NonRandomized Studies (MINORS) scoring system. The effect of Remplissage on external rotation of the shoulder was evaluated.
Results Fifteen articles were enrolled in the study, of which ten articles were in English (66.7%), five in Chinese (33.3%). For level of evidence, three studies were rated at Level Ⅲ (20%), and 12 were Level Ⅳ (80%). Totally 673 patients (674 shoulders) were included, of which 546 cases underwent Bankart repair with Remplissage procedure (B + R, 81.1%), 127 patients had isolated Bankart repair (B, 18.9%). Meta analysis showed that the average limit of lateral external rotation after (B + R) was 8.6^o (P＜0.001), but the external rotation at 90^o abduction had no statistical difference when compared with preoperative values (P=0.054). Compared with isolated Bankart repair, (B + R) had more severe impact of limiting external rotation on the shoulder joint by 0.74^o without significant difference (P=0.078).
Conclusion Bankart repair with Remplissage procedure will partially limit the external rotation function, and the surgical indications should be considered carefully according to the injury before surgery.

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