关节镜下肱二头肌腱切除及固定术与肱二头肌腱修补术对肩关节上盂唇前后部损伤疗效的Meta分析  

Effectiveness of Biceps Tendon Tenotomy and Fixation versus Biceps Tendon Repair through Arthroscopy for Shoulder Superior Labrum Anterior Posterior Lesions: A Meta-analysis

作　　者：杨晨[1] 赵晨[2] 汤军 葛新江 毕擎[2] 

机构地区：[1]新疆阿克苏地区第一人民医院骨科,新疆阿克苏843000 [2]浙江省人民医院骨科 [3]武义县中医院骨科

出　　处：《华西医学》2015年第3期426-431,共6页West China Medical Journal

基　　金：浙江省医药卫生科技计划项目(2012KYB010)~~

摘　　要：目的系统评价关节镜下肱二头肌腱切除及固定术与肱二头肌腱修补术比较治疗肩关节上盂唇前后部(SLAP)损伤的疗效。方法计算机检索Pub Med、EMbase、Cochrane图书馆(2014年3期)、中国生物医学文献数据库、维普网和中国期刊全文数据库,检索时间均为各数据库建库至2014年12月,并手工检索国内外已发表的有关骨科论文及会议资料,收集肱二头肌腱切除及固定术与肱二头肌腱修补术比较治疗肩关节SLAP损伤疗效的随机对照试验(RCT),由2名评价者按照纳入与排除标准选择试验、提取资料和评价质量后,采用采用Cochrane协作网提供的Rev Man 5.0软件进行Meta分析。结果最终纳入3个RCT,共计137例患者,Meta分析结果显示与肱二头肌腱修补术相比,肱二头肌腱切除及固定手术治疗肩关节SLAP损伤UCLA肩关节评分[WMD=3.43分,95%CI(2.29,4.56)分,P<0.000 01]、术后肩关节疼痛程度[WMD=1.18分,95%CI(0.30,2.05)分,P=0.009]、术后肩关节功能评价[WMD=0.96分,95%CI(0.51,1.41)分,P<0.000 1]以及术后患者满意度的评价[WMD=1.16分,95%CI(0.31,2.01)分,P=0.007]更优异,而两组在上肢前屈活动度[WMD=0.10分,95%CI(-0.87,1.06)分,P=0.84]、上肢前屈肌力[WMD=0.13分,95%CI(-0.09,0.35)分,P=0.25]的评分方面,其差异均无统计学意义。结论肱二头肌腱切除及固定术治疗肩关节SLAP损伤疗效优于肱二头肌腱修补术。由于纳入研究数量有限且方法学质量不高,研究结果尚需更多高质量的RCT进一步证实。Objective To evaluate the clinical therapeutic ef ect of biceps tendon tenotomy and fixation versus biceps tendon repair for shoulder superior labrum anterior posterior（SLAP） lesions with Meta-analysis. Methods The databases such as Pub Med, EMbase, the Cochrane Library（Issue 3, 2014）, CBM, VIP and CJFD（from the establishment time of databases to December 2014） were searched to collect all randomized controlled trials（RCT） on the clinical effectiveness of biceps tendon tenotomy and fixation versus biceps tendon repair for shoulder SLAP lesions. Two reviewers independently screened the literature according to the inclusive and exclusive criteria, extracted the data, and assessed the methodological quality of included studies. At er the data extraction and methodological quality evaluation,meta-analysis was conducted with Rev Man 5.0 software. Results Three RCT were included. Among the total 137 patients involved, Meta-analysis showed that, compared with the biceps tendon repair group, the biceps tenotomy group had superior amount in the UCLA score [WMD=3.43, 95%CI（2.29, 4.56）, P 〈 0.000 01], the shoulder pain [WMD=1.18, 95%CI（0.30, 2.05）, P=0.009], function [WMD=0.96, 95%CI（0.51, 1.41）, P 〈 0.000 1] and satisfaction [WMD=1.16, 95%CI（0.31, 2.01）, P=0.007] with signifficant dif erences. But there were no signifficant dif erences between the two groups in the shoulder flextion [WMD=0.10, 95%CI（-0.87, 1.06）, P=0.84] and strengtTh[WMD=0.13, 95%CI（-0.09, 0.35）, P=0.25]. Conclusions Based on the current studies, the biceps tenotomy and fixation is superior to the biceps tendon repair in treating shoulder SLAP lesions. For the quality restrictions and possible publication bias of the included studies, more double blind, high quality RCT are required to further evaluate the ef ects.

关 键 词：肱二头肌腱切除及固定术 肱二头肌腱修补术 肩关节上盂唇前后部损伤 系统评价 META分析 随机对照试验 

分 类 号：R687.2[医药卫生—骨科学]