单排固定与双排固定技术治疗肩袖全层撕裂疗效的Meta分析

Comparison of Curative Effect between Single-row and Double-row Fixation Technique for Arthroscopic Repair of Full-thickness Rotator Cuff Tears:A Meta Analysis

目的通过Meta分析方法比较关节镜下肩袖全层撕裂单排固定与双排固定技术的临床疗效。方法计算机系统检索Pub Med(1966年1月—2013年12月)、EMBase(1966年1月—2013年12月)、Springer(1966年1月—2013年12月)、Ovid(1966年1月—2013年12月)、Cochrane图书馆(2013年第4期)、中国生物医学文献数据库(1978年1月—2013年12月)、维普中文科技期刊数据库(1978年1月—2013年12月)中发表的所有相关文献,并查阅所有检出文献的参考文献目录以发现灰色文献。比较两种手术方式的临床及影像学治疗效果。采用Rev Man 5.1软件进行统计分析。结果共纳入6篇随机对照试验和2篇前瞻性队列研究。Meta分析结果显示:对照组与试验组Constant-Murley肩关节评分系统(CMS)评分比较,差异无统计学意义〔MD=-1.00,95%CI(-2.37,0.37),P=0.15〕;对照组与试验组美国肩肘外科评分系统(ASES)评分比较,差异有统计学意义〔MD=-0.84,95%CI(-1.66,-0.02),P=0.05〕;对照组与试验组洛杉矶加州大学肩关节评分系统(UCLA)评分比较,差异有统计学意义〔MD=-0.75,95%CI(-1.30,-0.20),P=0.007〕。试验组肩袖完整发生率高于对照组〔RR=0.81,95%CI(0.72,0.91),P=0.000 4〕;试验组部分撕裂发生率低于对照组〔RR=1.93,95%CI(1.20,3.11),P=0.007〕;两组全层撕裂发生率比较,差异无统计学意义〔RR=1.45,95%CI(0.88,2.41),P=0.15〕。亚组分析显示:对于肩袖撕裂长度<3 cm患者,试验组和对照组术后CMS评分、ASES评分、UCLA评分比较,差异无统计学意义(P>0.05)。对于肩袖撕裂长度≥3 cm患者,试验组和对照组术后ASES评分和UCLA评分比较,差异有统计学意义(P<0.05)。结论双排固定增加了术后肩袖完整性,提高了临床疗效,尤其是对于全层肩袖撕裂长度≥3 cm的患者更为有效,为临床治疗提供了参考依据。

Objective This study aims to use meta-analysis to compare clinical effects between single-row and double-row fixation techniques for patients with full thickness tears by arthroscopic check. Methods All the relevant literatures were identified by computer from Pub Med（ January 1966—December 2013）, EMBase（ January 1966—December 2013）,Springer（ January 1966—December 2013）,Ovid（ January 1966—2013 December）,the Cochrane Central Register of Controlled Trials（ Central,2013, Issue 4）, CBM（ January 1978 to December 2013） and VIP（ January 1978 to December2013）,relevant journals or conference proceedings were also searched manually for grey documents. The clinical and imaging effects of the two operations were compared. Rev Man 5. 1 software was used for statistical analysis. Results 6 randomized controlled trials and 2 prospective cohort studies were enrolled. The meta-analysis showed that CMS score of control group and trial group was not statistically different from each other 〔MD =-1. 00,95% CI（-2. 37,0. 37）,P = 0. 15 〕; the difference of ASES of the two groups was significant 〔MD =-0. 84,95% CI（-1. 66,-0. 02）,P = 0. 05〕; the difference of UCLA score between the two groups was significant 〔MD =-0. 75,95% CI（-1. 30,-0. 20）,P = 0. 007 〕. The incidence rate of full-thickness tears in trail group was higher than that in control group 〔RR = 0. 81,95% CI（ 0. 72,0. 91）,P = 0. 000 4 〕and the incidence of partial-thickness tears in trail group was lower than that in control group 〔RR = 1. 93,95% CI（ 1. 20,3. 11）,P = 0. 007 〕; no significant difference of complete cuff tear was found between the two groups 〔RR = 1. 45,95% CI（ Cochrane Handbook for Systematic Reviews of Interventions 5. 0（ 0. 88,2. 41）,P = 0. 15〕. Sub-group analysis showed that for patients with the length of rotator cuff tear 〈3 cm,the ASES score and UCLA score after operation between the two groups had no statistical significance（ P〉0. 05） and they had statistical significance if the length ≥3 cm（ P〈0. 05）. Conclusion The meta-analysis suggests that the double-row fixation technique increases post-operative rotator cuff integrity and improves the clinical outcomes,especially for patients with full-thickness rotator cuff tears larger than 3 cm,which provides reference for clinical treatment.