关节镜下经肌腱修复术和转全层修复术治疗肩袖关节侧部分撕裂临床疗效的Meta分析  

Transtendon technique versus repair after completion of the tear for articular-sided partial rotator cuff tear:a meta-analysis

作　　者：刘凯[1] 万峰麟 王永才[1] 黄秋 王红川[1] LIU Kai;WAN Fenglin;WANG Yongcai;HUANG Qiu;WANG Hongchuan(Department of Orthopedics,People's Hosipital of Leshan,Leshan,Sichuan 614000,P.R.China;Department of Orthopedics,People's Hosipital of Muchuan,Muchuan,Sichuan 614000,P.R.China)

机构地区：[1]乐山市人民医院关节外科,四川乐山614000 [2]沐川县人民医院骨科,四川沐川614000

出　　处：《华西医学》2024年第11期1753-1758,共6页West China Medical Journal

摘　　要：目的 通过Meta分析比较关节镜下经肌腱修复术和转全层修复术治疗肩袖关节侧部分撕裂的临床疗效。方法 检索Cochrane图书馆、Embase、Pub Med、维普中文科技期刊数据库、万方数据库以及中国知网,检索时段为数据库建立至2024年11月,搜集所有与关节镜下经肌腱修复术和转全层修复术治疗肩袖关节侧部分撕裂相关的随机对照试验。比较两种方法的疗效,结局指标为疼痛、术后美国肩肘外科协会(American Society for Shoulder-Elbow Surgery, ASES)评分、术后Constant-Murley评分、术后粘连性肩关节囊炎、术后再撕裂。应用Rev Man 5.3软件完成Meta分析,采用均数差(mean difference, MD)和相对危险度(relative risk, RR)进行分析。结果 共6篇随机对照试验纳入分析,包括370例患者,其中经肌腱修复组188例,转全层修复组182例。Meta分析结果显示:经肌腱修复组末次随访时疼痛评分[MD=0.26分,95%置信区间(confidence interval, CI)(0.09,0.42)分,P=0.003]和术后ASES功能评分[MD=2.02分,95%CI(0.95,3.10)分,P=0.000 2]高于转全层修复组,术后Constant-Murley功能评分低于转全层修复组[MD=-3.32分,95%CI(-6.17,-0.46)分,P=0.02];两组术后粘连性肩关节囊炎发生率[RR=1.12,95%CI(0.36,3.42),P=0.85]和再撕裂率[RR=0.32,95%CI(0.10,1.03),P=0.06]差异无统计学意义。结论 关节镜下经肌腱修复术治疗肩袖关节侧部分撕裂与转全层修复相比,术后疼痛程度稍高,两种手术术后粘连性肩关节囊炎和再撕裂发生率无明显差异。Objective To compare the clinical outcomes following arthroscopic repair for articular-sided partial rotator cuff tear using transtendon repair versus repair after completion of the tear by meta-analysis.Methodss Randomized controlled trials on arthroscopic repair for articular-sided partial rotator cuff tear using transtendon repair versus repair after completion of the tear were identified from Cochrane Library,PubMed,Embase,Chinese National Knowledge Infrastructure,Wanfang database,and Chongqing VIP database,with a timespan from the inception of database to November 2024.Pain score,American Shoulder and Elbow Surgeons(ASES)score,Constant-Murley score,postoperative adhesive capsulitis and postoperative retear were obtained as the outcomes to compare the clinical effect of the two methods.Meta-analyses were conducted using RevMan 5.3 software,with mean difference(MD)and relative risk(RR)as the effect scales.Results A total of 6 randomized controlled trial studies were included in the meta-analysis.The studies enrolled 370 patients,including 188 cases in the transtendon repair group and 182 cases in the repair after completion of the tear group.Pooled analyses demonstrated that the pain score[MD=0.26,95%confidence interval(CI)(0.09,0.42),P=0.003]and ASES score[MD=2.02,95%CI(0.95,3.10),P=0.0002]were higher in the transtendon repair group than those in the repair after completion of the tear group,the Constant-Murley score was lower in the transtendon repair group than that in the repair after completion of the tear group[MD=-3.32,95%CI(-6.17,-0.46),P=0.02],and there was no significant difference in the incidence of postoperative adhesive capsulitis[RR=1.12,95%CI(0.36,3.42),P=0.85]or the incidence of retear[RR=0.32,95%CI(0.10,1.03),P=0.06]between two groups.Conclusions Transtendon technique is less effective in reducing pain for articular-sided partial rotator cuff tear.There is no significant difference in the incidence of postoperative adhesive capsulitis or retear between the two gorups.

关 键 词：关节侧肩袖损伤 经肌腱修复 转全层修复 META分析 

分 类 号：R687.4[医药卫生—骨科学]