Eljabu Walid, Klinger Hans Michael, von Knoch Marius
Department of Traumatology, Hand Surgery and Orthopaedics, Klinikum Bremerhaven Reinkenheide gGmbH, Bremerhaven, Germany,
Arch Orthop Trauma Surg. 2015 Aug;135(8):1055-61. doi: 10.1007/s00402-015-2239-1. Epub 2015 May 6.
To analyse the current scientific evidence regarding the natural history of the clinical and anatomical progression of rotator cuff tears.
A broad systematic review of the literature (PubMed database through January 2014) which was guided, conducted and reported according to PRISMA criteria. This article focuses on the rotator cuff tears. Articles had to meet an inclusion criteria. The methodological quality of each study was individually assessed using a recently developed general assessment tool AMQPP (assessing the methodological quality of published papers).
Seven articles dealing with rotator cuff tears were included, one of them was a high-quality study. Three papers assessed the natural history and the natural course of rotator cuff rupture directly. The other studies indirectly assessed the natural history with reports on non-operative and operative therapy trends. All of these articles had been published in four different top medical journals according to 2013 ranking. We found no articles which clearly referred to the role of regression to the mean of rotator cuff tears.
The development of symptoms and anatomical deterioration are often directly correlated. Spontaneous recovery to normal levels of function has been successfully achieved, and standardised non-operative treatment programmes are an effective alternative to surgery for many patients. Follow-up is necessary to avoid irreparable stage. However, surgery is still favoured by young active people and highly professional persons who need to get fit in a short period of time. Further research is still necessary. The AMQPP score system is simple and reliable. It works as a quick quality-checking tool which helps researchers to identify the key points in each paper and reach a decision regarding the eligibility of the paper more easily.
分析目前关于肩袖撕裂临床及解剖学进展自然史的科学证据。
根据PRISMA标准对文献进行广泛的系统综述（截至2014年1月的PubMed数据库）。本文聚焦于肩袖撕裂。文章必须符合纳入标准。使用最近开发的通用评估工具AMQPP（评估已发表论文的方法学质量）对每项研究的方法学质量进行单独评估。
纳入了7篇关于肩袖撕裂的文章，其中1篇为高质量研究。3篇论文直接评估了肩袖撕裂的自然史和自然病程。其他研究通过非手术和手术治疗趋势的报告间接评估自然史。根据2013年排名，所有这些文章均发表于4种不同的顶级医学期刊。我们未发现明确提及肩袖撕裂均值回归作用的文章。
症状发展与解剖学恶化通常直接相关。已成功实现功能自发恢复至正常水平，标准化非手术治疗方案对许多患者而言是手术的有效替代方案。随访对于避免病情发展至无法挽回的阶段很有必要。然而，手术仍然受到年轻活跃人群以及需要在短时间内恢复健康的高职业要求人群的青睐。仍有必要进行进一步研究。AMQPP评分系统简单可靠。它作为一种快速质量检查工具，有助于研究人员识别每篇论文的关键点，并更轻松地就论文的合格性做出决定。
