肥胖影响肩袖修复术后结果的Meta分析  

Meta-analysis of obesity on the outcome of rotator cuff repair

作　　者：梁钧文 杨智涛 刘涛[1] 王锡豪 方森 张柏荣 韵向东[1,2] LIANG Jun-wen;YANG Zhi-tao;LIU Tao;WANG Xi-hao;FANG Sen;ZHANG Bai-rong;YUN Xiang-dong(Department of Orthopaedics,the Second Hospital of Lanzhou University,Lanzhou 730030,Gansu,China;Key Laboratory of Bone and Joint Disease of Gansu Province,Lanzhou 730030,Gansu,China)

机构地区：[1]兰州大学第二医院骨科,甘肃兰州730030 [2]甘肃省骨关节疾病研究重点实验室,甘肃兰州730030

出　　处：《中国骨伤》2023年第12期1196-1202,共7页China Journal of Orthopaedics and Traumatology

基　　金：甘肃省科技厅自然科学基金项目(编号:22JR11RA051);兰州大学第二医院“萃英科技创新”计划临床拔尖技术项目(编号:CY2019-BJ04)。

摘　　要：目的:系统评价肥胖对于肩袖修复术后结果的影响。方法:检索PubMed、Embase、Cochrane Library、Web of Science、中国生物医学文献数据库(China biology medicine,CBM)、知网、万方、维普数据库,收集建库至2022年8月1日比较肥胖与肩袖修复术后结果关系的全部文献,由2位作者各自独立根据纳排除标准对入选文献进行筛选。采用Endnote X9和Excel 2019进行文献提取、管理以及数据录入,并采用渥太华纽卡斯尔量表(Newcastle-Ottawa Scale,NOS)对纳入文献进行质量评价。采用STATA 16.0及RevMan 5.4软件对肥胖与非肥胖组术后再撕裂率、再手术率、并发症发生率,美国肩肘外科协会评分(American Shoulder and Elbow Surgeons,ASES),肩关节疼痛视觉模拟评分(visual analogue scale,VAS),手术时间,肩关节外旋角度进行Meta分析。结果:共纳入13篇文献,包括6篇回顾性研究,5篇病例对照研究,1篇前瞻性队列研究,1篇未能获取全文的研究摘要,共计85 503例患者(肥胖组31 973例,非肥胖组53 530例)。Meta分析结果显示,两组再撕裂率[OR=2.58,95%CI(1.23,5.41),P=0.01、再手术率[OR=1.31,95%CI(1.21,1.42),P<0.00]、并发症发生率[OR=1.57,95%CI (1.31,1.87),P=0.00]、ASES评分[MD=-3.59,95%CI(-5.45,-1.74),P=0.00]、VAS[MD=0.24,95%CI(0.00,0.49),P=0.05]比较差异有统计学意义,而手术时间[MD=6.03,95%CI(-7.63,19.69),P=0.39]、肩关节外旋角度[MD=-1.79,95%CI(-5.30,1.71),P=0.32]比较差异无统计学意义。结论:肥胖会导致肩袖修复术后更高的再撕裂率、再手术率、并发症发生率,更差的肩部功能和疼痛状况。Objective To systematically evaluate obesity on the outcome of rotator cuff repair.Methods Literatures on the relationship between obesity and outcomes after rotator cuff repair were searched from PubMel,Embase,Cochrane Library,Web of Science,China biology medicine(CBM),CNKI,Wanfang and VIP databases from building database to August1,2022,and were screened independently by two authors according to inclusion and exclusion criteria.Endnote X9 and Excel2019 were used for literature extraction,management and data entry,and Newcastle-Ottawa Scale(NOS) was used to evaluate quality of the included literatures-STATA 16.0 and RevMan 5.4 softwares were used to evaluate postoperative retear rate,reoperation rate,complication rate,American Shoulder and Elbow Surgeons(ASES) score,visual analogue scale(VAS),operative time and external rotation angle of shoulder joint pain were analyzed.Results Totally 13 literatures were included,including 6retrospective studies,5 case-control studies,1 prospective cohort study,and 1 abstract of a study for which the full text was not available,with 85 503 patients(31 973 in obese group and 53 530 in non-obese group).Meta-analysis showed there were statistical differences between two groups in retear rate [OR=2.58,95%CI(1.23,5.41),P=0.01],reoperation rate[OR=1.31,95%CI(1.21,1.42),P<0.00] complication rate [OR=1.57,95%CI(1.31,1.87),P=0.00],ASES score[MD=-3.59,95%CI(-5.45,-1.74),P=0.00],and VAS [MD=0.24,95%CI(0.00,0.49),P=0.05].While there were no differences between two groups in operative time [MD=6.03,95%CI(-7.63,19.69),P=0.39],external rotation angle of shoulder joint [MD=-1.79,95%CI(-5.30,1.71),P=0.32].Conclusion Obesity is associated with higher rates of retear,resurgery,complications,poorer shoulder function and pain after rotator cuff repair.

关 键 词：肥胖 肩袖修复术 预后 META分析 

分 类 号：R686.1[医药卫生—骨科学]