摘要
目的采用Meta分析的方法比较全关节镜与切开修复治疗肩袖撕裂的有效性和安全性。方法系统检索Embase、Medline、Cochrane Library、ClinicalTrials.gov、SinoMed、中国知网、维普、万方数据库发表的全关节镜与小切口或开放手术比较治疗肩袖撕裂的随机对照临床试验。检索日期均从数据库开始日期至2023年4月。采用Cochrane风险评估工具对纳入文献进行偏倚风险评价。采用Stata14.0进行Meta分析。比较组间术后肩关节功能评分、肩关节疼痛评分、肩关节活动范围(前屈与外旋度数)、手术时间、并发症(再撕裂与关节僵硬)的差异。结果共纳入9篇文献,共1018例患者,其中全关节镜512例、切开修复506例。Meta分析结果显示,两组的肩关节功能评分(SMD=-0.02,95%CI:-0.19~0.15,P=0.81)、肩关节疼痛评分(SMD=-0.02,95%CI:-0.18~0.14,P=0.84)、前屈活动度(MD=1.29,95%CI:-0.71~3.30,P=0.21)、外旋活动度(MD=-0.31,95%CI:-3.32~2.69,P=0.84)、再撕裂率(RR=1.22,95%CI:0.88~1.68,P=0.23)、关节僵硬率(RR=0.89,95%CI:0.48~1.64,P=0.71)等结局指标差异均无统计学意义。全关节镜组的手术时间长于切开修复组(MD=12.12,95%CI:2.03~22.21,P=0.02)。结论全关节镜与切开手术相比治疗肩袖撕裂的临床效果相近。
Background Rotator cuff tears are common in clinical practice,resulting in persistent shoulder pain and decreased joint motion.Foreign data show that the annual outpatient volume of rotator cuff diseases is more than 4.5 million cases,and the annual operation volume is about 40,000.Rotator cuff tear is mainly seen in middle-aged and elderly patients,and its incidence shows a significant increasing trend with age.The surgical treatment of rotator cuff tear can be divided into traditional open repair,arthroscopy-assisted small incision,and total endoscopic surgery.Total mirror surgery has the advantages of small skin incisions and slight tissue damage,but it is difficult to operate and has a long learning curve,and it has been gradually popularized in recent years.With the maturity of arthroscopic technology,full-scope repair of rotator cuff tears has gradually become mainstream,but its clinical effect compared with open repair is still controversial.The meta-analysis papers published in the past comparing full lens versus open incision repair were either carried out early randomized controlled trials(RCTS)not included,or a few RCTS were mixed with observational studies,failed to summarize the best evidence to illustrate the problem.Objectives To evaluate the efficacy and safety of arthroscopic and open rotator cuff repairs in treating rotator cuff tears.Methods mbase,Medline,Cochrane Library,ClinicalTrials.gov,SinoMed,CNKI,VIP,and Wanfang databases were searched to collect randomized controlled trials(RCT)that compared arthroscopic and open/mini-open rotator cuff repairs from inception to April 2023.The methodological quality of the included study was assessed using the Cochrane Risk Assessment Tool.Meta-analysis was performed using Stata 14.0 software.Results Eight studies were included in the meta-analysis,involving 750 patients(378 in the arthroscopic repair group and 372 in the open/mini-open repair group).There were no significant differences between the two groups in aspects of shoulder function score(SMD=-0
作者
郁凯
曾保起
杨剑
杨杰
张殿英
孙凤
Yu Kai;Zeng Baoqi;Yang Jian;Yang Jie;Zhang Dianying;Sun Feng(Department of Trauma Center,China Aerospace Science&Industry Corporation 731 Hospital,Beijing 100074,China;Department of Epidemiology and Health Statistics,School of Public Health,Peking University,Beijing 100191,China;Department of Orthopaedics,Tianjin Fifth Central Hospital,Tianjin 300450,China;Department of Orthopedics,Peking University People's Hospital,Beijing 100044,China)
出处
《中华肩肘外科电子杂志》
2024年第3期238-245,共8页
Chinese Journal of Shoulder and Elbow(Electronic Edition)
基金
中国中医药循证医学中心业务研究室主任专项(2020YJSZX-2)
国家自然科学基金(72074011)。
