| Objective: According to the inclusion of relevant literature,to evaluate effectiveness of open and arthroscopic surgery for the treatment of recurrent anterior dislocation of the shoulder joint,in order to provide evidence-based medical evidence for clinical decision.Methods: To searche domestic and abroad databases: Medline Cochrane,library,Embase,CNKI,CBM,Wan Fang database published from 2006 to-2016 years;At the same time,we searched for major domestic department of orthopedics related magazines,relevant literature references,including all randomized controlled studies and retrospective case-control study manually.The included studies were evaluated by two independent reviewers,and we would ask a higher level of evaluation for help in case of divergence.Finally,we extacted the date from included researches and meta analysis on finishing the extracted by Cochrane Re Man5.2 software.Results: According to the inclusion criteria and search strategy,8 literatures were included,1 Chinese,7 English,4 of which were randomized controlled trials,4 retrospective clinical trials;Only 1 pieces of Chinese quality were low,the rest of the 7 studies quality were high.As a result,we collected 648 cases,which includied open surgery 348 cases and 300 cases of arthroscopic surgery.The Meta analysis results showed that: 1.The main index,postoperative shoulder dislocation rate: a total of 648 Cases,including open surgery 348 cases,300 cases of arthroscopic surgery;The results showed that two kinds of surgical treatment of recurrent shoulder dislocation rate were no significant difference about recurrent anterior dislocation postoperatively.Heterogeneity test results(I2 =0,P=0.69),a fixed model was used,RR=0.66,[95%CI(0.37,1.17)].Z=1.43,P=0.15.The sensitivity analysis showed that excluding a relatively low quality studying,and the result of recurrent anterior dislocation postoperatively did not change,RR=0.74 [95%CI,(0.36,1.52)];Z=0.82,P=0.41,which meant the stability analysis was good.2.Secondary index,(1)The rate of reoperation postoperatively,a total of 4 studies included a total of 274 cases,including open surgery 108 cases,166 cases of arthroscopic surgery group,And the results showed that about two kinds of operation treatment of recurrent anterior dislocation of shoulder joint,the reoperation rate was no significant difference.The heterogeneity test(I 2 =0%,P=0.52),a fixed model was used,RR=1.37,[95%CI(0.45,4.20)];Z=0.55,P=0.58.(2)Back to previous work postoperatively,a total of 3 studies.A total of 226 patients were enrolled,including open surgery 104 cases,and 122 cases in arthroscopic surgery group,The results showed that two kinds of surgical treatment of recurrent anterior dislocation of shoulder joint after operation,returning the original work rate had no significant difference.Heterogeneity test results(I2 =0%,P=0.83),a fixed effect model was used;and RR=1.01,[95%CI(0.93,1.08)];Z=0.15,P=0.88.(3)Row score,a total of 3 studies included a total of 225 cases,including open surgery 86 cases,and 139 cases of arthroscopic in surgery group.The results showed that two kinds of surgical treatment of recurrent anterior dislocation of shoulder joint,there were no significant differences in Row score after the operation.The heterogeneity test(I2 =72%,P=0.03),a random model was used,and WMD=-0.85,[95%CI(-6.97,5.27)],Z=0.27,P=0.79.(4)Postoperative external rotation angle loss,a total of 4 studies included a total of 249 cases,including open surgery 108 cases,141 cases in arthroscopy group operation.The results showed that two kinds of surgical treatment of recurrent anterior dislocation of shoulder joint,postoperative external rotation angle loss had statistical significant differences.Heterogeneity test(I2 =0%,P=0.61),a fixed model was used,WMD=3.63,[95%CI(1.53,5.74)].Z=3.38,P<0.05.To postoperative external rotation angle,thefunnel plot(Funnel-plot)showed that the two sides were basically symmetrical,and there was little possibility of publication biasConclusion: Compared with open surgery,there was no significant difference about arthroscopic surgery in the treatment of recurrent anterior dislocation of shoulder joint,the postoperative dislocation rate,reoperation rate after operation,back to previous wirk,Row score,and they had the similar therapeutic effect with the development of arthroscope technology rapidly.However,about less external rotation the loss angle,arthroscopic surgery had an advantage over open repair,and it was worthy to be promoted and applied more. |
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