Brown Matthew J, Pula David A, Kluczynski Melissa A, Mashtare Terry, Bisson Leslie J
UBMD Orthopaedics and Sports Medicine, University at Buffalo, State University of New York at Buffalo, Buffalo, New York, U.S.A.
UBMD Orthopaedics and Sports Medicine, University at Buffalo, State University of New York at Buffalo, Buffalo, New York, U.S.A..
Arthroscopy. 2015 Aug;31(8):1576-82. doi: 10.1016/j.arthro.2015.02.004. Epub 2015 Mar 29.
To evaluate the effects of suture configuration, repair method, and tear size on rotator cuff (RC) repair healing.
We conducted a literature search of articles that examined surgical treatment of RC tears published between January 2003 and September 2014. For single-row (SR) repairs, we calculated rerupture rates for simple, mattress, and modified Mason-Allen sutures while stratifying by tear size. All double-row repairs-those using 2 rows of suture anchors (DA) and those using a suture bridge (SB)--were performed using mattress sutures, and we compared rerupture rates by repair method while stratifying by tear size. A random-effects model with pooled estimates for between-study variance was used to estimate the overall rerupture proportion and corresponding 95% confidence interval for each group. Statistical significance was defined as P < .05.
A total of 682 RC repairs from 13 studies were included. For SR repairs of tears measuring less than 3 cm, there was no significant difference in rerupture rates for modified Mason-Allen sutures versus simple sutures (P = .18). For SR repairs of tears measuring 3 cm or more, there was no significant difference in rerupture rates for mattress sutures versus simple sutures (P = .23). The rates of rerupture did not differ between SB and DA repairs for tears measuring less than 3 cm (P = .29) and 3 cm or more (P = .50).
For SR repairs, there were no significant differences in rerupture rates between suture techniques for any repair method or tear size. All DA and SB repairs were secured with mattress sutures, and there were no differences in the rates of rerupture between these methods for either size category. These findings suggest that suture technique may not affect rerupture rates after RC repair.
Level IV, systematic review of Level I through IV studies.
评估缝线构型、修复方法及撕裂大小对肩袖（RC）修复愈合的影响。
我们对2003年1月至2014年9月间发表的关于RC撕裂手术治疗的文章进行了文献检索。对于单排（SR）修复，我们计算了简单缝线、褥式缝线和改良梅森 - 艾伦缝线的再撕裂率，并按撕裂大小进行分层。所有双排修复——使用2排缝线锚钉（DA）的修复和使用缝线桥（SB）的修复——均采用褥式缝线进行，我们在按撕裂大小分层的同时，比较了不同修复方法的再撕裂率。使用具有研究间方差合并估计值的随机效应模型来估计每组的总体再撕裂比例及相应的95%置信区间。统计学显著性定义为P <.05。
共纳入13项研究中的682例RC修复。对于小于3 cm的撕裂进行SR修复时，改良梅森 - 艾伦缝线与简单缝线的再撕裂率无显著差异（P =.18）。对于3 cm及以上的撕裂进行SR修复时，褥式缝线与简单缝线的再撕裂率无显著差异（P =.23）。对于小于3 cm（P =.29）和3 cm及以上（P =.50）的撕裂，SB修复和DA修复的再撕裂率无差异。
对于SR修复，任何修复方法或撕裂大小的缝线技术之间的再撕裂率均无显著差异。所有DA和SB修复均采用褥式缝线固定，这两种方法在任何一种大小类别中的再撕裂率均无差异。这些发现表明缝线技术可能不会影响RC修复后的再撕裂率。
IV级，对I级至IV级研究的系统评价。
