Patients With Seizure Disorders Undergoing Surgery for Recurrent Anterior Shoulder Instability Show Variable Rates of Recurrence With Seizures as the Most Common Cause of Failure: A Systematic Review.
Scott Fong, Fabrizio Darby, Seema Patel, James D Fox, Michael S Lee, Jay Moran, Stephen M Gillinov, Mackenzie Norman, Justin Zhu, Ronak J Mahatme, John M Apostolakos, Andrew E Jimenez
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引用次数: 0
Abstract
Purpose: To evaluate postoperative outcomes of patients with seizure disorder undergoing stabilization surgery for the treatment of recurrent anterior shoulder instability.
Methods: PubMed, Cochrane Center for Register of Controlled Trials (Cochrane Center for Register of Controlled Trials), and Scopus were searched in January 2024 for articles using the Preferred Reporting Items for Systematic Reviews and Meta-analyses criteria. Articles were included if they evaluated postoperative functional, clinical, or recurrence/reoperation outcomes after surgical stabilization in patients with a history of seizures and recurrent anterior shoulder instability. For postoperative outcomes reported in 3 or more studies with mean and standard deviation, forest plots were generated, and I2 was calculated.
Results: A total of 8 studies were included: 7 studies focused on the Latarjet or other bone block augmentation procedures and 1 study focused on a soft tissue-only stabilization procedure. There were a total of 157 Latarjet or bone block augmentation surgeries (143 patients: 124 male [86.7%], 19 female [13.3%]) and 29 soft tissue-only stabilization surgeries (27 patients: 23 male [85.2%], 4 female [14.8%]). Recurrent dislocation or subluxation rates ranged from 0% to 43%. Of the 5 studies that reported the cause of postoperative dislocation or instability, 4 identified seizures as the cause of all cases. In studies comparing Latarjet outcomes between patients with versus without seizure disorders, instability recurrence ranged from 1.8% to 9.5% in the nonseizure group and from 9% to 40% in the seizure group.
Conclusions: The recurrence of anterior shoulder instability after surgical stabilization in patients with seizure disorders was variable across studies, ranging from 0% to 43%. Seizure was the most common reported cause for recurrent instability after surgery.
Level of evidence: Level IV, systematic review of Level III and IV studies.
目的：评价癫痫患者行稳定手术治疗复发性肩前路不稳的术后效果。方法：检索Pubmed、Cochrane Center for Register of Controlled Trials （CENTRAL）和Scopus于2024年1月使用系统评价和元分析首选报告项目（PRISMA）标准的文章。对有癫痫发作史和复发性肩前不稳的患者进行手术稳定后的术后功能、临床或复发/再手术结果进行评估的文章被纳入。对于在三个或三个以上的研究中报告的具有平均值和标准差的术后结果，生成森林图，并计算I2。结果：共纳入8项研究：7项研究聚焦于Latarjet或其他骨块增强手术，1项研究聚焦于仅用于软组织的稳定手术。共有157例Latarjet或骨块增强手术(143例：124例M（86.7%)， 19例F(13.3%)）和29例仅软组织稳定手术(27例：23例M（85.2%)， 4例F(14.8%)）。复发性脱位或半脱位率从0%到43%不等。在报告术后脱位或不稳定原因的五项研究中，四项确定癫痫发作是所有病例的原因。在比较有与无发作性疾病的患者的Latarjet结果的研究中，不稳定性复发在非发作组为1.8%至9.5%，在发作组为9%至40%。结论：在研究中，癫痫患者手术稳定后肩前路不稳的复发率从0%到43%不等。癫痫是手术后复发性不稳定最常见的原因。证据等级：IV级，对III级和IV级研究的系统评价。
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