中华关节外科杂志（电子版）
中華關節外科雜誌（電子版）
중화관절외과잡지（전자판）
CHINESE JOURNAL OF JOINT SURGERY(ELECTRONIC VERSION)
2015年
2期
229-236
,共8页
李梦远%顾宏林%马元琛%廖俊星%郑秋坚
李夢遠%顧宏林%馬元琛%廖俊星%鄭鞦堅
리몽원%고굉림%마원침%료준성%정추견
回旋套%撕裂伤%关节镜%Meta分析
迴鏇套%撕裂傷%關節鏡%Meta分析
회선투%시렬상%관절경%Meta분석
Rotator cuff%Lacerations%Arthroscopes%Meta-analysis
目的：采用Meta分析的方法比较关节镜下单排缝合与双排缝合治疗肩袖撕裂的临床疗效。方法计算机检索Scopus、Pubmed、Medline和Cochrane数据库，选择比较关节镜下单排缝合与双排缝合治疗肩袖撕裂临床疗效的随机对照研究，依照Cochrane系统评价方法进行质量评价后，对纳入研究进行资料提取，采用RevMan 5．1软件进行Meta分析，并使用GRADE系统评价证据质量和推荐等级。结果纳入文献7篇。从临床评分看，在术后≤1年的Constant评分（ WMD＝－3．40， P＞0．05）、ASES评分（WMD＝0．98， P＞0．05）、UCLA评分（P＞0．05）以及术后≥2年的Constant 评分（WMD＝0．82， P＞0．05）、ASES评分（WMD＝0．64， P＞0．05）上，单排组与双排组差异无统计学意义，但术后≥2年的UCLA评分（WMD＝0．59， P＜0．01）双排组占优；对大小≤3 cm的撕裂，术后Constant评分（P＞0．05）、ASES评分（WMD＝0．19， P＞0．05）、UCLA评分（WMD＝0．44， P＞0．05）差异无统计学意义，对大小≥3 cm的撕裂，术后Constant 评分（ P＞0．05）差异无统计学意义，而术后ASES评分（WMD＝1．45， P＜0．05）、UCLA评分（WMD＝0．63， P＜0．01）双排组占优。从肩关节肌力看（WMD＝－0．15， P＞0．05），两组术后无统计学差异。从关节活动度看，双排组在前屈（WMD＝5．41， P＜0．01）、外展（WMD ＝5．65， P＜0．01）方面优于排，但两组在内旋（WMD ＝0．89， P ＞0．05）、外旋（WMD＝0．36， P＞0．05）方面差异无统计学意义。双排组的术后肩袖愈合率（RR＝1．20， P＜0．01）高于单排组，单排组的术后部分愈合率（RR＝0．53， P＜0．05）高于双排组，但两组在术后再撕裂率（RR＝0．81， P＞0．05）方面差异无统计学意义。基于GRADE系统的证据推荐等级评价结果显示：单排组与双排组比较，肩袖愈合率的证据水平为低，推荐意见为弱推荐；部分愈合率的证据水平为低，推荐意见为弱推荐；再撕裂率的证据水平为中，推荐意见为弱推荐。结论双排缝合技术能部分改善肩袖撕裂患者术后肩关节功能，尤其对大小≥3 cm的撕裂，双排缝合技术虽然术后肩袖愈合率较高，但并不能降低术后再撕裂率。上述结论需要更多高质量大样本RCT加以验证。
目的：採用Meta分析的方法比較關節鏡下單排縫閤與雙排縫閤治療肩袖撕裂的臨床療效。方法計算機檢索Scopus、Pubmed、Medline和Cochrane數據庫，選擇比較關節鏡下單排縫閤與雙排縫閤治療肩袖撕裂臨床療效的隨機對照研究，依照Cochrane繫統評價方法進行質量評價後，對納入研究進行資料提取，採用RevMan 5．1軟件進行Meta分析，併使用GRADE繫統評價證據質量和推薦等級。結果納入文獻7篇。從臨床評分看，在術後≤1年的Constant評分（ WMD＝－3．40， P＞0．05）、ASES評分（WMD＝0．98， P＞0．05）、UCLA評分（P＞0．05）以及術後≥2年的Constant 評分（WMD＝0．82， P＞0．05）、ASES評分（WMD＝0．64， P＞0．05）上，單排組與雙排組差異無統計學意義，但術後≥2年的UCLA評分（WMD＝0．59， P＜0．01）雙排組佔優；對大小≤3 cm的撕裂，術後Constant評分（P＞0．05）、ASES評分（WMD＝0．19， P＞0．05）、UCLA評分（WMD＝0．44， P＞0．05）差異無統計學意義，對大小≥3 cm的撕裂，術後Constant 評分（ P＞0．05）差異無統計學意義，而術後ASES評分（WMD＝1．45， P＜0．05）、UCLA評分（WMD＝0．63， P＜0．01）雙排組佔優。從肩關節肌力看（WMD＝－0．15， P＞0．05），兩組術後無統計學差異。從關節活動度看，雙排組在前屈（WMD＝5．41， P＜0．01）、外展（WMD ＝5．65， P＜0．01）方麵優于排，但兩組在內鏇（WMD ＝0．89， P ＞0．05）、外鏇（WMD＝0．36， P＞0．05）方麵差異無統計學意義。雙排組的術後肩袖愈閤率（RR＝1．20， P＜0．01）高于單排組，單排組的術後部分愈閤率（RR＝0．53， P＜0．05）高于雙排組，但兩組在術後再撕裂率（RR＝0．81， P＞0．05）方麵差異無統計學意義。基于GRADE繫統的證據推薦等級評價結果顯示：單排組與雙排組比較，肩袖愈閤率的證據水平為低，推薦意見為弱推薦；部分愈閤率的證據水平為低，推薦意見為弱推薦；再撕裂率的證據水平為中，推薦意見為弱推薦。結論雙排縫閤技術能部分改善肩袖撕裂患者術後肩關節功能，尤其對大小≥3 cm的撕裂，雙排縫閤技術雖然術後肩袖愈閤率較高，但併不能降低術後再撕裂率。上述結論需要更多高質量大樣本RCT加以驗證。
목적：채용Meta분석적방법비교관절경하단배봉합여쌍배봉합치료견수시렬적림상료효。방법계산궤검색Scopus、Pubmed、Medline화Cochrane수거고，선택비교관절경하단배봉합여쌍배봉합치료견수시렬림상료효적수궤대조연구，의조Cochrane계통평개방법진행질량평개후，대납입연구진행자료제취，채용RevMan 5．1연건진행Meta분석，병사용GRADE계통평개증거질량화추천등급。결과납입문헌7편。종림상평분간，재술후≤1년적Constant평분（ WMD＝－3．40， P＞0．05）、ASES평분（WMD＝0．98， P＞0．05）、UCLA평분（P＞0．05）이급술후≥2년적Constant 평분（WMD＝0．82， P＞0．05）、ASES평분（WMD＝0．64， P＞0．05）상，단배조여쌍배조차이무통계학의의，단술후≥2년적UCLA평분（WMD＝0．59， P＜0．01）쌍배조점우；대대소≤3 cm적시렬，술후Constant평분（P＞0．05）、ASES평분（WMD＝0．19， P＞0．05）、UCLA평분（WMD＝0．44， P＞0．05）차이무통계학의의，대대소≥3 cm적시렬，술후Constant 평분（ P＞0．05）차이무통계학의의，이술후ASES평분（WMD＝1．45， P＜0．05）、UCLA평분（WMD＝0．63， P＜0．01）쌍배조점우。종견관절기력간（WMD＝－0．15， P＞0．05），량조술후무통계학차이。종관절활동도간，쌍배조재전굴（WMD＝5．41， P＜0．01）、외전（WMD ＝5．65， P＜0．01）방면우우배，단량조재내선（WMD ＝0．89， P ＞0．05）、외선（WMD＝0．36， P＞0．05）방면차이무통계학의의。쌍배조적술후견수유합솔（RR＝1．20， P＜0．01）고우단배조，단배조적술후부분유합솔（RR＝0．53， P＜0．05）고우쌍배조，단량조재술후재시렬솔（RR＝0．81， P＞0．05）방면차이무통계학의의。기우GRADE계통적증거추천등급평개결과현시：단배조여쌍배조비교，견수유합솔적증거수평위저，추천의견위약추천；부분유합솔적증거수평위저，추천의견위약추천；재시렬솔적증거수평위중，추천의견위약추천。결론쌍배봉합기술능부분개선견수시렬환자술후견관절공능，우기대대소≥3 cm적시렬，쌍배봉합기술수연술후견수유합솔교고，단병불능강저술후재시렬솔。상술결론수요경다고질량대양본RCT가이험증。
Objective To compare the clinical outcomes of arthroscopic rotator cuff repair of single-row versus double-row fixations with meta-analysis.Methods The databases including Scopus , Pubmed, Medline and Cochrane were searched to collect the randomized controlled trials ( RCTs) which compared arthroscopic single-row versus double-row repairs.According to the inclusion and exclusion criteria, data of the included studies were extracted , and the methodological quality was evaluated by Cochrane Handbook .The meta-analysis was performed using RevMan 5.1, and the evidence qualities and recommendation levels were determined according to the GRADE System .Results A total of seven RCTs were included .In the light of the clinical scales , the differences in the short-term Constant score ( WMD=-3.40, P>0.05), ASES (WMD=0.98, P>0.05), and UCLA (P>0.05), as well as the long-term Constant score (WMD =0.82, P >0.05) and ASES (WMD =0.64, P >0.05) were not significant between the two groups .However, the long-term UCLA ( WMD=0.59, P<0.01) was significantly higher in the double-row group.As for the cases with the tear size smaller than 3 cm, the differences in Constant score (P>0.05), ASES (WMD=0.19, P>0.05) and UCLA (WMD=0.44, P>0.05) between the two groups were not significant .In the cases with the tear size larger than 3 cm, the difference of Constant score(P>0.05) was not significant, but the values of ASES (WMD =1.45, P <0.05) and UCLA (WMD=0.63, P<0.01) were markedly higher in the double-row group.The difference in muscle force (WMD=-0.15, P>0.05) between the two group was not significant .Comparing the range of motion after surgery, the double-row group showed superior results in flexion ( WMD =5.41, P <0.01) and abduction (WMD=5.65, P<0.01), but not significantly better in internal rotation (WMD=0.89, P>0.05) or external rotation (WMD=0.36, P>0.05).The integrity of the rotator cuff (RR=1.20, P<0.01) was better but the partial healing rate (RR=0.53, P<0.05) was lower in the double-row group. The full-thickness retear rate ( RR=0.81, P>0.05) showed no difference between the two groups .Based on the GRADE system, the evidence level of the integrity of the rotator cuff was low with a weak recommendation;the evidence level of partial healing was low with a weak recommendation; the evidence level of full-thickness retear was moderate with a weak recommendation .Conclusion The Meta-analysis suggests that the double-row repair improves postoperative clinical outcomes in some way and increases the rotator cuff healing rate especially for the tears larger than 3 cm, but the full-thickness retear rate does not decrease.This conclusion still needs to be further proved by more high-quality and large-scale RCTs.
