肩袖撕裂的手术治疗或保守治疗：一项荟萃分析。
Surgery or conservative treatment for rotator cuff tear: a meta-analysis.
作者信息
Ryösä Anssi, Laimi Katri, Äärimaa Ville, Lehtimäki Kaisa, Kukkonen Juha, Saltychev Mikhail
机构信息
a Department of Orthopaedics and Traumatology , Turku University Hospital and University of Turku , Turku , Finland.
b Department of Physical and Rehabilitation Medicine , Turku University Hospital and University of Turku , Turku , Finland.
出版信息
Disabil Rehabil. 2017 Jul;39(14):1357-1363. doi: 10.1080/09638288.2016.1198431. Epub 2016 Jul 6.
PURPOSE
Comparative evidence on treating rotator cuff tear is inconclusive. The objective of this review was to evaluate the evidence on effectiveness of tendon repair in reducing pain and improving function of the shoulder when compared with conservative treatment of symptomatic rotator cuff tear.
METHOD
Search on CENTRAL, MEDLINE, EMBASE, CINAHL, Web of Science and Pedro databases. Randomised controlled trials (RCT) comparing surgery and conservative treatment of rotator cuff tear. Study selection and extraction based on the Cochrane Handbook for Systematic reviews of Interventions. Random effects meta-analysis.
RESULTS
Three identified RCTs involved 252 participants (123 cases and 129 controls). The risk of bias was considered low for all three RCTs. For Constant score, statistically insignificant effect size was 5.6 (95% CI -0.41 to 11.62) points in 1-year follow up favouring surgery and below the level of minimal clinically important difference. The respective difference in pain reduction was -0.93 (95% CI -1.65 to -0.21) cm on a 0-10 pain visual analogue scale favouring surgery. The difference was statistically significant (p = 0.012) in 1-year follow up but below the level of minimal clinically important difference.
CONCLUSION
There is limited evidence that surgery is not more effective in treating rotator cuff tear than conservative treatment alone. Thus, a conservative approach is advocated as the initial treatment modality. Implications for Rehabilitation There is limited evidence that surgery is not more effective in treating rotator cuff tear than conservative treatment alone. There was no clinically significant difference between surgery and active physiotherapy in 1-year follow-up in improving Constant score or reducing pain caused by rotator cuff tear. As physiotherapy is less proneness to complications and less expensive than surgery, a conservative approach is advocated as the initial treatment modality to rotator cuff tears.
目的
关于治疗肩袖撕裂的对比证据尚无定论。本综述的目的是评估与有症状肩袖撕裂的保守治疗相比，肌腱修复在减轻疼痛和改善肩部功能方面有效性的证据。
方法
检索CENTRAL、MEDLINE、EMBASE、CINAHL、科学引文索引和佩德罗数据库。比较肩袖撕裂手术治疗和保守治疗的随机对照试验（RCT）。基于Cochrane干预系统评价手册进行研究选择和提取。随机效应荟萃分析。
结果
三项纳入的RCT涉及252名参与者（123例病例和129例对照）。所有三项RCT的偏倚风险均被认为较低。对于Constant评分，在1年随访中，支持手术的效应量在统计学上无显著意义，为5.6（95%CI -0.41至11.62）分，低于最小临床重要差异水平。在0-10疼痛视觉模拟量表上，支持手术的疼痛减轻差异为-0.93（95%CI -1.65至-0.21）cm。该差异在1年随访中具有统计学意义（p = 0.012），但低于最小临床重要差异水平。
结论
证据有限，表明手术治疗肩袖撕裂并不比单纯保守治疗更有效。因此，提倡采用保守方法作为初始治疗方式。康复治疗的意义证据有限，表明手术治疗肩袖撕裂并不比单纯保守治疗更有效。在1年随访中，手术和积极物理治疗在改善Constant评分或减轻肩袖撕裂引起的疼痛方面无临床显著差异。由于物理治疗比手术更少发生并发症且成本更低，提倡采用保守方法作为肩袖撕裂的初始治疗方式。
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