肩袖修复术后早期与延迟被动活动范围：一项系统评价和荟萃分析。
Early Versus Delayed Passive Range of Motion After Rotator Cuff Repair: A Systematic Review and Meta-analysis.
作者信息
Kluczynski Melissa A, Nayyar Samir, Marzo John M, Bisson Leslie J
机构信息
Department of Orthopaedics, School of Medicine and Biomedical Sciences, University at Buffalo, The State University of New York, Buffalo, New York.
Department of Orthopaedics, School of Medicine and Biomedical Sciences, University at Buffalo, The State University of New York, Buffalo, New York
出版信息
Am J Sports Med. 2015 Aug;43(8):2057-63. doi: 10.1177/0363546514552802. Epub 2014 Oct 8.
BACKGROUND
Postoperative rehabilitation has been shown to affect healing of the rotator cuff after surgical repair. However, it is unknown whether an early or delayed rehabilitation protocol is most beneficial for healing.
PURPOSE
To determine whether early versus delayed passive range of motion (PROM) affects rotator cuff (RC) retear rates after surgery.
STUDY DESIGN
Systematic review and meta-analysis.
METHODS
A systematic review of the literature published between January 2003 and February 2014 was conducted. Retear rates were compared for early (within 1 week after surgery) versus delayed (3-6 weeks after surgery) PROM using χ(2) or Fisher exact tests as well as relative risks (RR) and 95% CIs. In the first analysis, data from evidence level 1 studies that directly compared early versus delayed PROM were pooled; and in the second analysis, data from level 1 to 4 studies that did not directly compare early versus delayed PROM were pooled. The second analysis was stratified by tear size and repair method.
RESULTS
Twenty-eight studies (1729 repairs) were included. The first analysis of level 1 studies did not reveal a significant difference in retear rates for early (13.7%) versus delayed (10.5%) PROM (P = .36; RR = 1.30 [95% CI, 0.74-2.30]). The second analysis revealed that for ≤3 cm tears, the risk of retear was lower for early versus delayed PROM for transosseous (TO) plus single-row anchor (SA) repairs (18.7% vs 28.2%, P = .02; RR = 0.66 [95% CI, 0.47-0.95]). For >5 cm tears, the risk of retear was greater for early versus delayed PROM for double-row anchor (DA) repairs (56.4% vs 20%, P = .002; RR = 2.82 [95% CI, 1.31-6.07]) and for all repair methods combined (52.2% vs 22.6%, P = .01; RR = 2.31 [95% CI, 1.16-4.61]). There were no statistically significant associations for tears measuring <1 cm, 1 to 3 cm, 3 to 5 cm, and >3 cm.
CONCLUSION
Evidence is lacking with regard to the optimal timing of PROM after RC repair; however, this study suggests that tear size may be influential.
背景
术后康复已被证明会影响肩袖手术修复后的愈合。然而，早期或延迟康复方案对愈合是否最有益尚不清楚。
目的
确定早期与延迟被动活动范围（PROM）对术后肩袖（RC）再撕裂率的影响。
研究设计
系统评价和荟萃分析。
方法
对2003年1月至2014年2月发表的文献进行系统评价。使用χ²检验或Fisher精确检验以及相对危险度（RR）和95%可信区间（CI）比较早期（术后1周内）与延迟（术后3 - 6周）PROM的再撕裂率。在第一次分析中，汇总直接比较早期与延迟PROM的1级研究数据；在第二次分析中，汇总未直接比较早期与延迟PROM的1级至4级研究数据。第二次分析按撕裂大小和修复方法分层。
结果
纳入28项研究（1729例修复）。对1级研究的第一次分析未发现早期（13.7%）与延迟（10.5%）PROM的再撕裂率有显著差异（P = 0.36；RR = 1.30 [95% CI，0.74 - 2.30]）。第二次分析显示，对于≤3 cm的撕裂，经骨（TO）加单排锚钉（SA）修复时，早期PROM的再撕裂风险低于延迟PROM（18.7%对28.2%，P = 0.02；RR = 0.66 [95% CI，0.47 - 0.95]）。对于>5 cm的撕裂，双排锚钉（DA）修复以及所有修复方法联合应用时，早期PROM的再撕裂风险高于延迟PROM（56.4%对20%，P = 0.002；RR = 2.82 [95% CI，1.31 - 6.07]）以及（52.2%对22.6%，P = 0.01；RR = 2.31 [95% CI，1.16 - 4.61]）。对于<1 cm、1至3 cm、3至5 cm和>3 cm的撕裂，无统计学显著关联。
结论
关于肩袖修复后PROM的最佳时机缺乏证据；然而，本研究表明撕裂大小可能有影响。
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