早期肩峰撞击综合征关节镜下肩峰减压术与非手术治疗效果比较的Meta分析

Meta-analysis of arthroscopic decompression and non-surgical treatment for early stage shoulder impingement syndrome

目的 通过Meta分析的方法对关节镜下肩峰减压术与非手术治疗早期肩峰撞击综合征的有效性进行比较,以期为临床治疗肩峰撞击综合征提供循证依据。方法 计算机检索PubMed、Embase、Cochrane图书馆、中国知网、万方等数据库(检索时间为建库至2021-05-02)中比较非手术治疗和关节镜下肩峰减压术治疗早期肩峰撞击综合征的临床随机对照研究,经过严格的质量评价后使用Review Manager 5.3软件进行Meta分析。评价指标为肩关节疼痛评分与肩关节功能评分,并将Meta分析结果分为短期随访组(<2年)与长期随访组(≥2年)进行亚组分析。结果 共纳入7项临床随机对照研究,包含607例患者。Meta分析结果显示,关节镜下肩峰减压术与非手术治疗相比,功能评分在短期内(SMD=0.12;95%CI:-0.18~0.43;P=0.42)和长期内(SMD=0.30;95%CI:-0.06~0.66;P=0.10)差异均无统计学意义;疼痛评分在短期内(SMD=-0.06;95%CI:-0.28~0.17;P=0.62)和长期内(SMD=-0.12;95%CI:-0.39~0.15;P=0.38)差异同样无统计学意义。结论 治疗早期肩峰撞击综合征患者,关节镜下肩峰减压术与非手术治疗相比无明显优势,建议优先选择非手术治疗。

Objective To compare the eficiency of arthroscopic decompression and non-surgical treatment for early stage shoulder impingement syndrome.Methods PubMed, Embase, Cochrane Library, CNKI, Wanfang and other databases were searched by computer(search time was from the establishment of the database to 2021-05-02) for clinical randomized controlled studies comparing non-surgical treatment with arthroscopic acromial decompression in the treatment of early acromial impaction syndrome. Meta-analysis was performed by using Review Manager 5.3 software after rigorous quality evaluation. The evaluation indexes were shoulder pain score and shoulder function score, and the results of meta-analysis were divided into short-term subgroup(<2 years) and long-term subgroup(≥2 years).Results Seven randomized controlled trials(RCTs) were included, involving a total of 607 patients. There were no significant differences in shoulder function scores between arthroscopic decompression and non-surgical treatment whether in long-term group(SMD=0.30;95%CI:-0.06--0.66;P=0.10) or short-term follow-up subgroup(SMD= 0.12;95%CI:-0.18-0.43;P=0.42). There were no significant differences in shoulder pain scores either whether in long-term group(SMD=-0.12;95% CI:-0.39-0.15;P=0.38) or short-term follow-up subgroup(SMD=-0.06;95%CI:-0.28-0.17;P=0.62).Conclusions No significant difference is demonstrated in the treatment of early stage shoulder impingement syndrome between arthroscopic decompression and non-surgical treatment in the Meta-analysis, thus non-surgical treatment should be chosen firstly for patients with early stage shoulder impingement syndrome.