早期康复运动与延迟康复运动对肩袖损伤术后中-长期影响的Meta分析

Meta-analysis of the mid-and long-term effects of early and delayed rehabilitation on postoperativerotator cuff injury

目的通过Mate分析比较早期康复运动与延迟康复运动对肩袖损伤患者术后中-长期的影响。方法检索国内、外截止2020年7月11日已发表的临床随机对照研究。所检索的数据库包括:中国知网、维普、万方、CBM、Pubmed、Cochrane Library、Embase等。由2位研究者独立进行文献筛选、资料提取和纳入文献的偏倚风险评价后,提取结局指标(VAS评分、Constan-Murley评分、SST评分、肩关节前屈角度、肩关节外展外旋角度、肩袖再撕裂),采用Review Manager 5.3软件进行数据分析。结果依据以上检索策略,共检索到相关文献641篇,最终纳入8篇文献,共720例患者。Mate分析结果显示,早期康复运动组与延迟康复运动组在术后VAS评分[MD=0.02,95%CI=-0.10~0.14,P>0.05]、Constant-Murley评分[MD=0.89,95%CI=-1.47~3.26,P>0.05]、SST评分[MD=0.19,95%CI=-0.22~0.59,P>0.05]、肩关节前屈角度[MD=1.11,95%CI=-1.43~3.65,P>0.05]、肩关节外展外旋角度[MD=1.36,95%CI=0.97~3.70,P>0.05]、肩袖再撕裂[MD=0.96,95%CI=0.48~1.94,P>0.05]等6个术后指标的比较中均无明显差异。结论早期康复运动组患者术后中-长期肩袖再撕裂发生率与延迟康复运动组无明显差异,说明肩袖修补术后的早期康复运动同样安全;两组患者在术后中-长期VAS评分、Constant-Murley评分、SST评分、肩关节前屈角度、肩关节外展外旋角度等方面无明显差异,说明两组患者的术后疼痛、肩关节功能、自我感觉等无明显异常,提示肩袖损伤修补术后的早期康复运动同样有效。

Background The rotator cuff consists of the supraspinatus,infraspinatus,teres minor,and subscapularis,attached to the greater or lesser tuberosity at the upper end of the humerus.The tendons of these four muscles around the shoulder joint form a cuff-like structure,which is figuratively called the rotator cuff.The injuries of these tendons and soft tissues are called rotator cuff injuries.Arthroscopic rotator cuff repair is a clinically recognized and effective treatment for rotator cuff injury.Studies have illustrated that early rehabilitation is superior to delayed rehabilitation in shoulder motion,pain,and selfperception.Objective To compare the mid-and long-term effects of early rehabilitation and delayed rehabilitation on postoperative rotator cuff injury by MATE analysis.Methods The published domestic and foreign clinical randomized controlled trials were searched as of July 11,2020.The databases searched include CNKI,CQVIP,Wanfang Data,CBM,Pubmed,Cochrane Library,Embase,etc.Two investigators independently conducted literature screening,data extraction,and evaluation of the risk of bias in the included literatures.They then extracted the outcome indicators(VAS score,Constant-Murley score,SST score,flexion,abduction and external rotation,and retear).Review Manager 5.3 software was utilized for data analysis.Results Based on the above search strategy,641 relevant documents were retrieved,and 8 documents were finally included,with 720 patients.The results of Mate analysis showed that there was no significant difference in the comparison of early rehabilitation group and delayed rehabilitation group in postoperative VAS score of[MD=0.02,95%CI=-0.10~0.14,P>0.05],and the postoperative Constant-Murley score[MD=0.89,95%CI=-1.47~3.26,P>0.05],postoperative SST score[MD=0.19,95%CI=-0.22~0.59,P>0.05],postoperative shoulder flexion[MD=1.11,95%CI=-1.43~3.65,P>0.05],postoperative shoulder abduction and external rotation[MD=1.36,95%CI=0.97~3.70,P>0.05],postoperative rotator cuff retear[MD=0.96,95%CI=0.48~1.94,P>0.05].Conclusion There was no significant difference in the incidence of mid-and long-term rotator cuff retearing in the early mobilization group and the delayed rehabilitation group,indicating that early mobilization after rotator cuff repair was equally safe;the two groups of patients had medium and long-term VAS scores,There was no significant difference in Constant-Murley score,SST score,shoulder flexion,shoulder abduction,and external rotation,indicating that the two groups of patients had no apparent abnormalities in postoperative pain,shoulder joint function,and self-feeling,suggesting early rehabilitation after rotator cuff repair is also effective.There was no significant difference in the incidence of mid-and longterm rotator cuff retear in the early rehabilitation and delayed rehabilitation groups,indicating that early rehabilitation after rotator cuff repair was equally safe.There were no significant differences between the two groups in mid-and long-term VAS scores,Constant-Murley scores,SST scores,shoulder flexion,shoulder abduction,and external rotation,indicating that the two groups of patients had no apparent abnormalities in postoperative pain,shoulder joint function,and self-perception,suggesting that the early rehabilitation after rotator cuff repair is equally effective.