关节镜下缝线桥技术与双排技术治疗肩袖撕裂的Meta分析

A Meta-analysis of arthroscopic suture bridge technique and double-row technique for treating rotator cuff tears

目的通过Meta分析评估关节镜下缝线桥(suture bridge,SB)技术与双排(double-row,DR)技术治疗肩袖撕裂的临床疗效。方法系统检索PubMed、Embase、Web of Science、Cochrane Library、中国知网、维普和万方数据库,搜集关于关节镜下SB与DR治疗肩袖撕裂的对照研究。数据由两位作者独立提取,并由RevMan 5.3进行统计学分析。评价指标包括再撕裂率、康斯坦特肩关节功能(Constant)评分、美国肩肘外科协会(American shoulder and elbow surgeons,ASES)评分、日本骨科协会评估治疗(Japanese orthopaedic association,JOA)评分、美国加州大学肩关节(The shoulder rating scale of the university of california at los angeles,UCLA)评分、疼痛视觉模拟评分(visual analogue score,VAS)、外旋、前屈以及外展。结果本研究共纳入文献13篇(1145例)。其中SB技术组600例,DR技术组545例。SB技术的再撕裂率低于DR技术(OR=0.53,P=0.02),但在Constant评分(MD=-0.10,P=0.83)、ASES评分(MD=0.20,P=0.89)、JOA评分(MD=0.63,P=0.60)、UCLA评分(MD=-0.29,P=0.53)、VAS评分(MD=-0.17,P=0.08)、外旋(MD=0.54,P=0.39)、前屈(MD=0.94,P=0.53)和外展(MD=0.68,P=0.66)等方面两种技术的差异无统计学意义。结论关节镜下SB和DR修复在肩袖撕裂中都取得了良好的临床疗效,但在降低再撕裂率方面SB修复优于DR修复。关节镜下SB技术可作为治疗肩袖撕裂患者的首要选择。

Objective To compare the clinical efficacy of arthroscopic suture bridge (SB) and double-row(DR) intervention.Methods A systematic search of PubMed,Embase,Web of Science,Cochrane Library,CNKI,VIP and Wanfang databases was conducted to identify all comparative studies on arthroscopic treatment of rotator cuff tears with SB and DR.The data were extracted by 2 of the co-authors independently and were analyzed by RevMan 5.3.Evaluation indexes included Constant score,American Shoulder and Elbow Surgeons (ASES) score,Japanese Orthopaedic Association (JOA) score,Shoulder Rating Scale of the University of California at Los Angeles (UCLA),Visual Analogue Scale (VAS),external rotation,forward flexion and external stretch.Results This Meta-analysis selected 13 studies with a total of 1145 patients.There were 600 cases in the SB group and 545 cases in the DR group.The re-tear rate of the SB technique was significantly lower than that of the DR technique (OR=0.53,P=0.02),but no statistically significant differences in Constant score (MD=-0.10,P=0.83),ASES score (MD=0.20,P=0.89),JOA score (MD=0.63,P=0.60),UCLA score (MD=-0.29,P=0.53),VAS (MD=-0.17,P=0.08),external rotation (MD=0.54,P=0.39),forward flexion (MD=0.94,P=0.53) and external stretch (MD=0.68,P=0.66) were observed between the two techniques.Conclusions Both arthroscopic SB and DR interventions have achieved good clinical results in the treatment of rotator cuff tears.SB technique has lower re-tear rate than that of the DR so that SB is recommended as the first choice for patients with rotator cuff tear.