摘要
目的分析近年针对肩袖损伤行肩袖补片或非补片修复手术的对照试验,对治疗效果进行Meta分析,为选择恰当的手术方式提供参考;回顾近五年(2018~2022年)有关肩袖补片的研究,并比较不同补片类型之间的差异,探究不同补片的临床应用场景,揭示未来的研究方向。方法在文献数据库PubMed、Web of Science、中国知网中筛选相关文献,提取数据,采用Revman5.4进行Meta分析,比较肩袖补片手术与常规修复手术的临床结局,进行系统评价。结果共筛选出9篇文献进行Meta分析。与对照组相比,肩袖补片组的再撕裂率显著降低[OR=0.18,95%CI(0.09,0.35),P<0.00001];术后0~12个月、24个月及以上的随访中视觉模拟评分均无显著差异[MD=-0.28,95%CI(-1.00,0.44),P=0.45]、[MD=-1.72,95%CI(-3.82,0.37),P=0.11];术后6个月、24个月及以上随访的Constant-Murley肩关节评分均有显著提高[MD=2.68,95%CI(1.23,4.13),P=0.0003]、[MD=1.38,95%CI(0.22,2.54),P=0.02],但术后12个月随访的Constant-Murley肩关节评分无显著差异[MD=1.53,95%CI(-1.74,4.81),P=0.36];术后0~12个月、24个月及以上美国肩肘协会评分均无显著差异[MD=1.84,95%CI(-1.60,5.29),P=0.29]、[MD=6.83,95%CI(-0.10,13.77),P=0.05];术后0~12个月西安大略肩袖疾病评分指数无显著差异[MD=3.25,95%CI(-15.45,21.94),P=0.73],但术后24个月及以上西安大略肩袖疾病评分指数显著提高[MD=15.45,95%CI(1.50,29.34),P=0.03];术后肩关节前屈及外旋均无显著差异[MD=6.26,95%CI(-9.52,22.03),P=0.44]、[MD=-5.29,95%CI(-10.66,0.08),P=0.05]。结论补片修复能够提高肩袖撕裂修复的临床结局,降低再撕裂率。补片类型和手术技术的选择还有待进一步的临床研究。
Background Rotator cuff tears are a common cause of shoulder dysfunction,and their prevalence is difficult to quantify,ranging from 20.7%in a study of 683 subjects to 22%in 104 subjects aged 65 years and older.The main symptoms of rotator cuff tears are pain and limited mobility,and risk factors include advanced age and certain occupations.The treatment of rotator cuff tears includes non-surgical treatment and surgical treatment.Currently,surgical treatment is the primary treatment,and the repair technique is determined by the thickness,size,and shape of the tear,but the retear rate of conventional repair surgery is very high.In recent years,research on rotator cuff patches has led to new solutions,especially for patients with large rotator cuff tears,which promote healing of the tendon-bone interface and provide higher biomechanical stability.There are generally three types of mesh materials:heterogeneous mesh,allograft(allogeneic,autograft),and synthetic mesh.Several studies have shown that these types of rotator cuff patches can improve clinical outcomes.There are still some controversies regarding the clinical efficacy of the rotator cuff patch and the possible inflammatory reaction.The research of rotator cuff patches is still a new technique in the repair of rotator cuff tears.Objective To investigate the controlled trials of rotator cuff patch or non-patch repair for rotator cuff injury in recent years and to perform a Meta-analysis of the therapeutic effect to provide a reference for selecting the appropriate surgical method;to review the research on rotator cuff patch in the past five years(2018-2022),and to compare the differences between different patch types,to explore the clinical application scenarios of different patches,and to reveal the future research direction.Methods The relevant literature was screened in PubMed,Web of Science,and CNKI,the data were extracted,and a meta-analysis was performed with Revman 5.4 to compare the clinical outcomes of rotator cuff patch surgery and conventional repair surgery for systematic review.Results A total of 9 articles were selected for Meta-analysis.Compared with the control group,the rotator cuff patch group had a significantly lower retear rate[OR=0.18,95%CI(0.09,0.35),P<0.00001];there were no significant differences in visual analogue scale scores during follow-up at 0-12 months and more than 24 months(including 24 months)after surgery[MD=-0.28,95%CI(-1.00,0.44),P=0.45],[MD=-1.72,95%CI(-3.82,0.37),P=0.11];Constant-Murley scores were significantly increased at 6 months and more than 24 months(including 24 months)after surgery[MD=2.68,95%CI(1.23,4.13),P=0.0003],[MD=1.38,95%CI(0.22,2.54),P=0.02].However,there was no significant difference in Constant-Murley scores during follow-up at 12 months after surgery[MD=1.53,95%CI(-1.74,4.81),P=0.36];there was no significant difference in American shoulder and elbow surgeons scores during follow-up at 0-12 months and more than 24 months(including 24 months)after surgery[MD=1.84,95%CI(-1.60,5.29),P=0.29],[MD=6.83,95%CI(-0.10,13.77),P=0.05];there was no significant difference in western ontario rotator cuff index during follow-up at 0-12 months after surgery[MD=3.25,95%CI(-15.45,21.94),P=0.73],but it increased significantly during follow-up at more than 24 months(including 24 months)after surgery[MD=15.45,95%CI(1.50,29.34),P=0.03];postoperative shoulder flexion and external rotation were not significantly different[MD=6.26,95%CI(-9.52,22.03),P=0.44],[MD=-5.29,95%CI(10.66,0.08),P=0.05].Conclusion Patch repair can improve the clinical outcome of rotator cuff tear repair and reduce the retear rate.The choice of patch type and surgical technique remains to be further investigated clinically.
作者
施澄熙
李昊岳
吴兴源
邵振兴
崔国庆
Shi Chengxi;Li Haoyue;Wu Xingyuan;Shao Zhenxing;Cui Guoqing(Department of Sports Medicine,Peking University Third Hospital,Institute of Sports Medicine of Peking University,Beijing Key Laboratory of Sports Injuries,Beijing 100191,China)
出处
《中华肩肘外科电子杂志》
2023年第3期258-268,共11页
Chinese Journal of Shoulder and Elbow(Electronic Edition)
