SHOULDER & ELBOW
Anatomic Bankart repair compared with nonoperative treatment and/or arthroscopic lavage for first-time traumatic shoulder dislocation
この研究はハイインパクトの可能性があります。
OEのAI駆動型ハイインパクト指標は、論文が掲載されたジャーナルと論文自体の科学的内容の両方からのシグナルを統合することで、論文が持つ可能性の高い影響力を推定します。
最先端の自然言語処理を用いて開発されたOEハイインパクトモデルは、ジャーナルのインパクトファクターのみよりも、研究の将来の引用実績をより正確に予測します。
これにより、臨床的に意義のある研究をより早く認識することが可能になり、読者は将来の診療を形成する可能性が最も高い論文に集中することができます。
OrthoEvidence Journal (OE Journal) - ACE Report
OE Journal. 2013;1(6):77 Arthroscopy. 2012 Apr;28(4):565-75. doi: 10.1016/j.arthro.2011.11.012. Epub 2012 Feb 144 studies (228 patients) were included in this meta-analysis which compared the outcome of anatomic Bankart repair with both arthroscopic lavage and sling immobilization for the treatment of first time anterior shoulder dislocations at a minimum of 2 years. The results indicated that recurrent instability of the shoulder was significantly reduced through the use of anatomic Bankart repair, and quality of life was improved as measured by the Western Ontario Shoulder Instability questionnaire. Patient satisfaction was similar between treatment methods.
Were the search methods used to find evidence (original research) on the primary question or questions stated?
Was the search for evidence reasonably comprehensive?
Were the criteria used for deciding which studies to include in the overview reported?
Was the bias in the selection of studies avoided?
Were the criteria used for assessing the validity of the included studies reported?
Was the validity of all of the studies referred to in the text assessed with use of appropriate criteria (either in selecting the studies for inclusion or in analyzing the studies that were cited)?
Were the methods used to combine the findings of the relevant studies (to reach a conclusion) reported?
Were the findings of the relevant studies combined appropriately relative to the primary question that the overview addresses?
Were the conclusions made by the author or authors supported by the data and or analysis reported in the overview?
How would you rate the scientific quality of this evidence?
はい = 1
不確実＝0.5
無関係 = 0
いいえ = 0
報告基準評価では、著者が出版物内で試験の方法論的特徴や試験特性を報告する際の透明性を評価します。評価は以下の5つのカテゴリーに分類されます。
4/4
Introduction
4/4
Accessing Data
4/4
Analysing Data
4/4
Results
3/4
Discussion
Detsky AS, Naylor CD, O'Rourke K, McGeer AJ, L'Abbé KA. J Clin Epidemiol. 1992;45:255-65
Fragility Indexは、重要な所見の解釈を助けるツールで、結果の強さの尺度を提供します。Fragility Indexは、その所見が有意でなくなるために、二項対立の結果に追加する必要がある連続した事象の数を表します。数値が小さいほど弱い所見を表し、数値が大きいほど強い所見を表します。
なぜ今この研究が必要なのですか？
The recurrence rate following primary anterior shoulder dislocation has been reported to be as high as 67 percent when treated with conservative treatments such as sling immobilization. Two surgical interventions, arthroscopic lavage without concomitant capsuloligamentous repair (the gold standard) and anatomic Bankart repair, may reduce this high recurrence rate. However, the ideal management of first-time shoulder dislocation has not been established due to limitations in the analyses of the current literature. The objective of this publication was to perform a systematic review and meta-analysis which compared the efficacy of anatomic Bankart repair with arthroscopic lavage and sling immobilization in treatment of anterior shoulder dislocation.
主な研究課題は何ですか？
Was a lower rate of recurrent instability and improved quality of life achieved in the treatment of anterior shoulder dislocation with the use of anatomic Bankart repair compared to arthroscopic lavage and sling immobilization?
重要な知見は？
- Three different Bankart repair methods were used in the included trials, 1 study used the Caspari technique (transglenoid suture fixation), 1 study used bioabsorbable tacks, and 2 studies used suture anchors.
- Analysis of all 4 trials indicated that recurrent instability was significantly reduced among patients who had received anatomic Bankart repair than those who had received either of the controls (surgical lavage or nonsurgical immobilization). (RR 0.18, 95%CI 0.10-0.33)
- Subgroup analysis indicated that superiority of reduced recurrent instability with anatomic Bankart repair remained when compared separately with arthroscopic lavage (RR 0.14, 95%CI 0.06-0.31) and sling immobilization (RR 0.26, 95%CI 0.10-0.67)
- Quality of life measured in 2 studies with the Western Ontario Shoulder Instability (WOSI) questionnaire significantly favoured treatment with Bankart repair than treatment through lavage and immobilization. (MD -222.02, 95%CI -346.06 to -97.97)
- Analysis of 2 studies which reported patient satisfaction observed no significant difference between anatomic Bankart repair and the control groups. (RR 1.92, 95%CI 0.63-5.87)
- 88.6% of patients identified in the studies were male.
- Complications were not reported.
最も覚えておくべきことは？
The use of anatomic Bankart repair for the treatment of anterior shoulder dislocation provided improvement in recurrent instability and WOSI-measured quality of life when compared to arthroscopic lavage and sling immobilization. Patient satisfaction was not impacted by type of treatment.
それが私の患者ケアにどのように影響するか？
The results of this study suggest that anatomic Bankart repair improved outcomes in patients with first-time shoulder dislocation. However, limitations of the studies included (small sample sizes, nonuniform reporting, short follow-up, unclear methodology and data analysis) require future well-designed studies to effectively determine the efficacy of anatomic Bankart repair compared to other methods of treatment for anterior shoulder dislocation. These studies should use consistent repair methods, uniform outcome measures and should report complication in detail.
免責事項
このページに記載されている内容は、情報提供のみを目的としたものであり、専門的な医療アドバイス、診断、治療の代わりとなるものではありません。治療が必要な場合は、必ず医師の診断を仰ぐか、最寄りの救急外来を受診してください。このページに記載されている内容に関して個人が表明した意見、信念、見解は、OrthoEvidenceの意見、信念、見解を反映するものではありません。
0の4 月間無料記事のロック解除
