All-arthroscopic rotator cuff repair versus mini-open for the treatment of rotator cuff injury: a Meta-analysis

doi:10.3969/j.issn.2095-4344.2016.20.018

Abstract

Abstract:

BACKGROUND: There are controversies about the efficacy of all-arthroscopic rotator cuff repair versus mini-open for the treatment of rotator cuff injury.
OBJECTIVE: To evaluate the efficacy of all-arthroscopic rotator cuff repair versus mini-open for the treatment of rotator cuff injury by conducting a meta-analysis.
METHODS: A computer-based online search was conducted in PubMed, Embase, Cochrane Library and CBM databases from January 1966 to November 2015 to screen the relevant articles using the key words of “rotator cuff, arthroscopy, mini-open”. Meta-analysis was performed using Revman5.3 software.
RESULTS AND CONCLUSION: A total of 11 studies, including 6 randomized controlled trials and 5 cohort studies, were selected. The meta-analysis results showed that there were no significant differences in the function and strength of the shoulder joint, pain, motor range, recurrence of rotator cuff avulsion, the incidence rate of ankylosis between both two groups (P > 0.05). These results suggest that the efficacy of all- arthroscopic rotator cuff repair does not differ from those of mini-open for the treatment of rotator cuff injury. However, arthroscopic rotator cuff repair induces less soft tissue injury and early incision pain, but better function recovery.

中国组织工程研究杂志出版内容重点：组织构建；骨细胞；软骨细胞；细胞培养；成纤维细胞；血管内皮细胞；骨质疏松；组织工程

Key words: Arthroscopes, Treatment Outcome, Meta-Analysis

CLC Number:

R318

Wang Yi, Zhao Qi-chun. All-arthroscopic rotator cuff repair versus mini-open for the treatment of rotator cuff injury: a Meta-analysis[J]. Chinese Journal of Tissue Engineering Research, 2016, 20(20): 3022-3031.

Figures/Tables 2

2.1 文献搜索结果及纳入研究描述共计有863篇相关的文献被检出，经阅读文题、摘要及全文等筛选，最终共收集到11篇符合筛选标准[2，3，6，16-23]，其中6篇是随机对照试验[2，6，16-19]，5篇是队列研究[3，20-23]。其中2篇是中文文章[2，22]，9篇是英文文章[3，6，16-21，23]。纳入研究的基本特征见表1。 2.2 纳入研究的质量评价所有研究均进行了两组间的基线资料比较，差异无统计学意义。6篇RCT试验中有2篇研究地点在国内，4篇研究地点在国外，按Cochrane系统评价结果见表2及图1。6篇队列研究中1篇研究地点在国内，5篇在国外，按非随机对照试验评价有2篇评分为6.75分[22-23]，2篇7.5分[3，20]，1篇217.75分[2]，均为高质量队列研究。 2.3 荟萃分析的结果 2.3.1 修复后肩关节功能评分共有10篇研究均报告了肩关节镜与小切口两组治疗肩袖损伤后功能评分的情况[2，3，6，16-18，20-23]，共596例，其中全肩关节镜手术组302例，小切口组 294例。评价指标主要采用加州大学洛杉矶分校肩关节评定量表(UCLA)[2]、美国肩与肘协会评估表(ASES)以及Constant Murley肩关节评分系统(CMS)[2，6]。各研究间评分标准不同，使用标准化均数差作为效应指标进行异质性检验发现各研究间无明显异质性(chi²=15.79，P=0.07，I²=43%)，故采用固定效应模型进行分析。结果显示两组间肩关节功能评分无统计学差异(标准化均数差=0.12，95%CI=-0.04-0.29，P=0.13)，两种方法修复后肩关节功能相同(图2)。但有研究显示关节镜组修复后患者早期的关节功能恢复更快，Zwaal等[6]报道术后6周时关节镜组dash及Constant Murley肩关节评分系统评分明显高于小切口组，王峰等[2]报道修复后6周关节镜组患者的加州大学洛杉矶分校肩关节评定量表评分、美国肩与肘协会评估表评分均优于小切口组，这是因为关节镜组组织损伤小，早期疼痛更轻，患者更愿意进行主被动活动，有助于肩关节功能的恢复。"

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