关节镜下单排改良Mason-Allen技术与缝线桥技术治疗肩袖撕裂的meta分析

A meta-analysis of arthroscopic single-row modified Mason-Allen technique and suture bridge technique for treating rotator cuff tears

目的系统评价关节镜下单排改良Mason-Allen(MA)技术与缝线桥技术治疗肩袖撕裂的临床疗效。方法计算机检索Cochrane图书馆、PubMed、Embase、Web of Science、中国生物医学文献数据库(CBM)、维普中文科技期刊数据库(VIP)、中国知网(CNKI)及万方等数据库,检索时间为建库至2020年12月,收集比较关节镜下单排改良MA与缝线桥(SB)技术治疗肩袖撕裂的对照研究。采用RevMan 5.3.5软件进行meta分析,比较两组患者术后再撕裂率及康斯坦特肩关节功能(Constant)、美国肩肘外科协会(ASES)、主观肩关节估值(SSV)评分,以及西安大略肩袖指数(WORC)、疼痛视觉模拟评分(VAS)、植入锚钉数等。结果共纳入6篇研究,374例患者。其中单排改良MA组(MA组)200例,SB组174例。meta分析结果显示,两组患者在再撕裂率(OR=1.07,95%CI:0.52~2.19,P=0.85)、Constant评分(MD=-0.08,95%CI:-7.14~6.97,P=0.98)、ASES评分(MD=-5.48,95%CI:-16.73~5.77,P=0.34)、SSV评分(MD=-1.46,95%CI:-5.55~2.63,P=0.48)方面比较,差异均无统计学意义(P>0.05);但SB组WORC评分优于MA组(MD=4.43,95%CI:0.36,8.51,P=0.03);两组患者术后VAS比较差异无统计学意义(MD=0.49,95%CI:-0.26~1.23,P=0.20);但MA组植入锚钉数低于SB组(MD=-1.83,95%CI:-2.22~-1.44,P<0.01)。结论关节镜下单排改良MA技术和SB技术在肩袖撕裂中的临床疗效相似,但单排改良MA技术植入锚钉数明显低于SB技术,其具有更低的医疗费用成本。

Objective To investigate the clinical effects of arthroscopic single-row modified Mason-Allen(MA)technique and suture bridge technique in treating rotator cuff tear.Methods The control studies on the comparison between arthroscopic single-row modified MA technique and suture bridge technique in treating rotator cuff tear were retrieved from the databases of Cochrane Library,PubMed,Embase,Web of Science,CBM,VIP,CNKI and Wanfang.The retrieval time was from the database establishment to December 2020.The RevMan 5.3.5 software was adopted for conducting the meta analysis.The postoperative re-tear rate,Constant shoulder function score,American Shoulder and Elbow Surgeons(ASES)score,subjective shoulder value(SSV)score,Western Ontario Rotator Cuff Index(WORC)score,pain visual analogue score(VAS)score and number of implanted anchors were compared between the two groups.Results Six studies were included with 374 patients.There were 200 cases in the single-row modified MA group and 174 cases in the suture bridge(SB)group.The meta-analysis results showed that there was no statistically significant differences in the re-tear rate(OR=1.07,95%CI:0.52-2.19,P=0.85),Constant score(MD=-0.08,95%CI:-7.14-6.97,P=0.98),ASES score(MD=-5.48,95%CI:-16.73-5.77,P=0.34)and SSV score(MD=-1.46,95%CI:-5.55-2.63,P=0.48)between the two groups.The WORC score in the SB group was better than that in the MA group,and the difference was statistically significant(MD=4.43,95%CI:0.36-8.51,P=0.03).The postoperative VAS score had no statistical difference between the two groups(MD=0.49,95%CI:-0.26-1.23,P=0.20);the number of implanted anchors in the MA group was significantly fewer than that in the SB group,and the difference was statistically significant(MD=-1.83,95%CI:-2.22--1.44,P<0.01).Conclusion The single-row modified MA technique and suture bridge technique have the similar clinical efficacy in the treatment of rotator cuff tears,but the number of implanted anchors in the single-row modified MA technique is significantly lower than that in the SB technique,which has lower medical costs.