关节镜下锁骨远端切除对合并肩锁关节炎的肩袖修复术后疗效影响的Meta分析  

Efficacy of arthroscopic distal clavicle resection in repair of rotator cuff with acromioclavicular arthritis： a Meta-analysis

作　　者：任江涛[1] 徐丛[1] 王建松[1] 刘向林[1] 

机构地区：[1]承德医学院附属医院关节外科,河北省承德市067000

出　　处：《中华创伤骨科杂志》2017年第1期17-22,共6页Chinese Journal of Orthopaedic Trauma

摘　　要：目的系统评价关节镜下锁骨远端切除（DCR）对合并肩锁关节炎的肩袖修复（RCR）术后临床疗效的影响。方法计算机检索Pubmed、Medline、Embase、The Cochrane Library、CBM和万方数据库，查找国内外关于关节镜下DCR对合并肩锁关节炎的RCR术后临床疗效影响的相关文献，比较关节镜下DCR联合RCR患者与关节镜下只进行RCR未进行DCR患者的临床疗效，检索时间均为建库至2016年5月。由2位研究者独立筛选文献、提取资料和评价纳入研究的偏倚风险后，采用RevMan5．3软件进行Meta分析。对纳入的随机对照研究（RCT）和临床对照他研究（CCT）分别采用Cochrane系统评价员手册和非随机研究方法指数量表（MINORS）进行质量评价。结果共纳入5篇文献，其中RCT文献3篇，CCT文献2篇，共计465例患者。关节镜下DCR联合RCR患者与未进行DCR患者在疼痛视觉模拟评分（VAS）、肩关节Constant评分、美国肩肘外科（ASES）评分、肩关节活动度、术后肩锁关节疼痛、术后肩袖再撕裂方面差异均无统计学意义（P〉0．05）。3篇RCT文献均为中偏倚风险，2篇CCT文章的MINORS评分均为21分。结论关节镜下DCR对合并肩锁关节炎的RCR术后在肩关节VAS评分、Constant评分、ASES评分、肩关节活动度及术后并发症方面无明显优势，不推荐常规应用。Objective To systematically review the efficacy of arthroscopie distal clavicle resection （DCR） in repair of rotator cuff （RCR） with acromioclavicular arthritis. Methods The Cochrane Library, PubMed, Medline EMbase, CBM and WanFang Data were searched for studies up to May 2016 concerning the efficacy of arthroscopic distal clavicle resection in repair of rotator cuff with acromioclavicular arthritis. Two reviewers independently screened the literature according to the inclusion and exclusion criteria, extracted the data and assessed the methodological quality of the studies included. Next, meta-analysis was performed using RevMan 5.3 software to compare the efficacy between the patients undergoing arthroscopie DCR plus RCR and those undergoing simple arthroscopic RCR. The randomized control trails （RCT） and clinical control trials （CCT） included were evaluated according to Coehrane Handbook for Systematic Reviews of Interventions （Version 5.1.0） and Methodological Index for Non-randomized Studies （MINORS）, respectively. Results A total of 5 studies （3 RCTs and 2 CCTs） involving 465 patients were included. No statistically significant difference was found between the RCR and the DCR plus RCR patients in Visual Analogue Scale （VAS） score, Constant score, American Shoulder and Elbow Surgeons （ASES） score, shoulder range of motion （ROM）, postoperative acromioclavicular pain or rotator cuff retear （ P 〉 0. 05） . The 3 RCTs showed mod- erate bias risk and the 2 CCTs scored 21 MINORS points. Conclusion Since current evidence shows no advantages of arthroscopic DCR over RCR in repair of rotator cuff with acromioclavicular arthritis in VAS score, Constant score, ASES score, shoulder ROM, postoperative acromioclavicular pain or rotator cuff retear, arthroseopic DCR should not be recommended for routine use in clinic.

关 键 词：META分析 关节镜检查 肩关节 关节炎 

分 类 号：R687.4[医药卫生—骨科学]