肩袖损伤行关节镜与开放手术治疗的Meta分析

Meta-analysis of comparison of efficacy of arthroscopy and open surgery in treating rotator cuff injury

目的针对肩袖损伤时行关节镜及开放手术治疗效果进行Meta分析,为选择恰当的手术方式提供参考。方法经PubMed、The Cochrane Library、CNKI及WanFang Data检索相关文献,筛选关节镜与开放手术两种术式修复肩袖损伤的前瞻性研究(2000年1月至2021年9月),提取所需数据,并使用RevMan5.2进行分析。结果共筛选出6篇随机对照研究,2篇前瞻性队列研究。Meta分析结果显示:在关节镜及开放手术术后3~6周的随访中,VAS、ASES及CMS差异具有统计学意义[MD=-0.40,95%CI(-0.57,-0.23),P<0.01]、[MD=3.32,95%CI(1.03,5.60),P<0.01]、[MD=2.12,95%CI(0.50,3.75),P=0.01],肩关节活动度差异无统计学意义[MD=9.46,95%CI(-2.13,21.05),P=0.11]、[MD=3.99,95%CI(-1.18,9.15),P=0.13];而在术后12~24月的随访中,VAS、ASES、CMS及肩关节活动度差异均无统计学意义[MD=-0.02,95%CI(-0.23,0.20),P=0.89]、[MD=0.35,95%CI(-0.71,1.41),P=0.52]、[MD=-0.23,95%CI(-2.67,2.22),P=0.86]、[MD=0.85,95%CI(-0.56,2.26),P=0.24]、[MD=0.42,95%CI(-1.01,1.86),P=0.57]。结论比较关节镜及开放手术修复肩袖损伤的术后疗效,关节镜在术后早期疼痛缓解及功能恢复中可能更具优势,而在术后肩关节活动度及术后晚期疼痛缓解与功能恢复中两种术式具有相似的疗效。

Objective To conduct Meta⁃analysis on the therapeutic effects of arthroscopic and open surgery repair for rotator cuff injury,and to provide a reference for choosing an appropriate surgical method.Methods PubMed,The Co⁃chrane Library,CNKI and WanFang Data were searched for relevant literature,and the prospective studies on arthroscopic and open surgery in repairing rotator cuff injuries from January 2000 to September 2021 were screened.The required data were extracted and analyzed using RevMan5.2.Results A total of 6 randomized controlled studies and 2 prospective cohort studies were screened.Meta⁃analysis results showed that during the follow⁃up of 3~6 weeks after arthroscopic and open sur⁃gery,VAS,ASES,and CMS were statistically significant(MD=-0.40,95%CI-0.57 to-0.23,P<0.01),(MD=3.32,95%CI 1.03 to 5.60,P<0.01),and(MD=2.12,95%CI 0.50 to 3.75,P=0.01),but there was no significant difference in shoul⁃der mobility(MD=9.46,95%CI-2.13 to 21.05,P=0.11),(MD=3.99,95%CI-1.18 to 9.15,P=0.13);during the follow⁃up of 12-24 months after surgery,there was no significant difference in VAS,ASES,CMS,and shoulder mobility(MD=-0.02,95%CI-0.23 to 0.20,P=0.89),(MD=0.35,95%CI-0.71 to 1.41,P=0.52),(MD=-0.23,95%CI-2.67 to 2.22,P=0.86),(MD=0.85,95%CI-0.56 to 2.26,P=0.24)and(MD=0.42,95%CI-1.01 to 1.86,P=0.57).Conclu⁃sion The postoperative efficacy of arthroscopic and open surgery for rotator cuff repair were compared,and it was found that arthroscopy might be more beneficial in the early stage of postoperative pain relief and functional recovery,while both surgical methods shared similar therapeutic effects in terms of postoperative shoulder mobility and postoperative pain relief and functional recovery in the later stage.