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 Disserta...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展开更多
目的研究改良关节镜双袢法Latarjet手术治疗癫痫患者伴复发性肩关节前脱位的临床疗效。方法自2014年10月至2016年10月,共有9例伴发严重骨缺损的肩关节前脱位癫痫患者在深圳大学第一附属医院接受了改良关节镜双袢法Latarjet手术,患者平...目的研究改良关节镜双袢法Latarjet手术治疗癫痫患者伴复发性肩关节前脱位的临床疗效。方法自2014年10月至2016年10月,共有9例伴发严重骨缺损的肩关节前脱位癫痫患者在深圳大学第一附属医院接受了改良关节镜双袢法Latarjet手术,患者平均年龄为(26.3±3.1)岁,术前均进行超过半年的抗癫痫治疗,术后继续进行抗癫痫治疗1年。术后立刻行CT检查观察骨块位置,分别于术后3、6、12、24个月随访行CT检查观察骨块吸收、愈合情况;并记录患者的美国肩与肘协会评分系统(American shoulder and elbow surgeon’form,ASES)评分、Rowe评分以及Walch-Duplay评分并进行肩关节功能评估。结果共8例患者得到全程随访,平均随访(20.1±4.2)个月,3例患者术后再发癫痫(未按时服药),分别为术后2、6、8个月,其中1例(术后6个月癫痫复发)失访,其余2例复发者CT显示骨块明显移位,随后经保守治疗后再次愈合。全部随访患者骨块愈合良好,6例恢复对抗运动,2例恢复正常生活,无肩关节不稳感,CT检查显示移植骨块最终塑形差异较大,其中4例吸收5%~75%,3例较原始状态面积扩大,1例无变化。术前及末次随访时平均ASES评分为(76.75±7.41)分和(94.68±5.02)分(P<0.05),Rowe评分为(43.75±5.82)分和(93.13±5.30)分(P<0.05),Walch-Duplay评分为(76.13±6.98)分和(93.00±2.00)分(P<0.05)。结论改良关节镜双袢法Latarjet技术对于癫痫患者合并肩关节前脱位具有良好的短期临床疗效,且复发后有再次愈合的可能。但更应注意癫痫患者的术后病情控制,尽可能防止癫痫再发作导致手术失败,肩关节复发脱位。展开更多
Background: The purpose of this case series was to retrospectively compare radiological, clinical and functional outcomes and complications of diagnostic arthroscopy with open Latarjet procedures pre- and postoperativ...Background: The purpose of this case series was to retrospectively compare radiological, clinical and functional outcomes and complications of diagnostic arthroscopy with open Latarjet procedures pre- and postoperatively within one year after surgery. Additionally we compared the pathologic findings during diagnostic arthroscopy with the radiological findings in preoperative contrast enhanced CT or MRI scans. Methods: Between 07/2009 and 11/2013 46 cases with unidirectional antero-inferior shoulder instability were enrolled, 4 cases were lost during the follow-up within one year postoperatively. Plain radiographs, contrast enhanced multislice studies, Instability Severity Index, Constant, Duplay and Rowe Scores were obtained preoperatively. Diagnostic arthroscopy was performed in all cases prior to open Latarjet procedure. At one year follow-up Constant, Duplay and Rowe Scores were obtained;position and consolidation of the coracoid transfer were assessed by conventional x-ray studies. Results: At one year follow-up a significant improvement of all scores was recorded (Constant Score 95.8 vs. 86.7;Duplay Score 93.7 vs. 25.2, Rowe Score 98.1 vs. 31.7, (p Conclusion: The Latarjet procedure is a reliable technique with very good clinical outcomes. Diagnostic arthroscopy is a valuable tool to detect HAGL- and IGHL-lesions and to visualize the engaging potential of Hill-Sachs-lesions. An additional arthroscopy may help to indicate a Latarjet procedure and to address concomitant pathologies. Level of evidence: Level IV, case series.展开更多
文摘目的通过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
文摘目的研究改良关节镜双袢法Latarjet手术治疗癫痫患者伴复发性肩关节前脱位的临床疗效。方法自2014年10月至2016年10月,共有9例伴发严重骨缺损的肩关节前脱位癫痫患者在深圳大学第一附属医院接受了改良关节镜双袢法Latarjet手术,患者平均年龄为(26.3±3.1)岁,术前均进行超过半年的抗癫痫治疗,术后继续进行抗癫痫治疗1年。术后立刻行CT检查观察骨块位置,分别于术后3、6、12、24个月随访行CT检查观察骨块吸收、愈合情况;并记录患者的美国肩与肘协会评分系统(American shoulder and elbow surgeon’form,ASES)评分、Rowe评分以及Walch-Duplay评分并进行肩关节功能评估。结果共8例患者得到全程随访,平均随访(20.1±4.2)个月,3例患者术后再发癫痫(未按时服药),分别为术后2、6、8个月,其中1例(术后6个月癫痫复发)失访,其余2例复发者CT显示骨块明显移位,随后经保守治疗后再次愈合。全部随访患者骨块愈合良好,6例恢复对抗运动,2例恢复正常生活,无肩关节不稳感,CT检查显示移植骨块最终塑形差异较大,其中4例吸收5%~75%,3例较原始状态面积扩大,1例无变化。术前及末次随访时平均ASES评分为(76.75±7.41)分和(94.68±5.02)分(P<0.05),Rowe评分为(43.75±5.82)分和(93.13±5.30)分(P<0.05),Walch-Duplay评分为(76.13±6.98)分和(93.00±2.00)分(P<0.05)。结论改良关节镜双袢法Latarjet技术对于癫痫患者合并肩关节前脱位具有良好的短期临床疗效,且复发后有再次愈合的可能。但更应注意癫痫患者的术后病情控制,尽可能防止癫痫再发作导致手术失败,肩关节复发脱位。
文摘Background: The purpose of this case series was to retrospectively compare radiological, clinical and functional outcomes and complications of diagnostic arthroscopy with open Latarjet procedures pre- and postoperatively within one year after surgery. Additionally we compared the pathologic findings during diagnostic arthroscopy with the radiological findings in preoperative contrast enhanced CT or MRI scans. Methods: Between 07/2009 and 11/2013 46 cases with unidirectional antero-inferior shoulder instability were enrolled, 4 cases were lost during the follow-up within one year postoperatively. Plain radiographs, contrast enhanced multislice studies, Instability Severity Index, Constant, Duplay and Rowe Scores were obtained preoperatively. Diagnostic arthroscopy was performed in all cases prior to open Latarjet procedure. At one year follow-up Constant, Duplay and Rowe Scores were obtained;position and consolidation of the coracoid transfer were assessed by conventional x-ray studies. Results: At one year follow-up a significant improvement of all scores was recorded (Constant Score 95.8 vs. 86.7;Duplay Score 93.7 vs. 25.2, Rowe Score 98.1 vs. 31.7, (p Conclusion: The Latarjet procedure is a reliable technique with very good clinical outcomes. Diagnostic arthroscopy is a valuable tool to detect HAGL- and IGHL-lesions and to visualize the engaging potential of Hill-Sachs-lesions. An additional arthroscopy may help to indicate a Latarjet procedure and to address concomitant pathologies. Level of evidence: Level IV, case series.
