Orthopedics Department, The Second Affiliated Hospital of Jiaxing University, Jiaxing, Zhejiang Province, China.
PLoS One. 2018 Nov 15;13(11):e0207306. doi: 10.1371/journal.pone.0207306. eCollection 2018.
Scientific evidence is not clear regarding the routine use of acromioplasty in the treatment of rotator cuff repair. The aim of this study was to compare clinical outcomes between patients undergoing arthroscopic rotator cuff repair with and without concomitant acromioplasty.
Medline, Cochrane Library, and EMBASE databases were searched to identify eligible studies focused on arthroscopic rotator cuff repair with and without acromioplasty from January 2000 to February 2018. Postoperative functional outcomes, visual analog scale (VAS) for pain and reoperation rate were extracted for systemic analysis.
Six randomized controlled trials (RCTs) and one cohort study (CS), including 651 patients, fulfilled our selection criteria. The results showed a significant difference in American Shoulder and Elbow Surgeons (ASES) score, but not in the Constant score, University of California-Los Angeles (UCLA) score, or Simple Shoulder Test (SST) score, in the treatment of rotator cuff tear with or without concomitant acromioplasty at the final follow-up. In the subgroup analysis, the results showed no significant differences between the two treatments in reoperation rate at the final follow-up or VAS score at 6 months postoperatively and final follow-up, but there was a significant difference in VAS score at 12 months postoperatively in favor of acromioplasty treatment. The evidence quality for each outcome evaluated by the GRADE system was low.
In summary, our present study demonstrated that acromioplasty treatment is significantly superior to nonacromioplasty in shoulder pain relief at 12 months postoperatively and in ASES score improvement at the final follow-up in conjunction with rotator cuff repair. However, these significant differences were not clinically relevant. Thus, there were no differences in shoulder function or pain scores for patients undergoing rotator cuff repair with and without acromioplasty. Further high-quality studies with larger sample sizes and long-term follow-ups are needed to clarify this issue.
关于在肩袖修复术中常规使用肩峰成形术，科学证据尚不清楚。本研究的目的是比较关节镜下肩袖修复术伴或不伴肩峰成形术的临床疗效。
检索 Medline、Cochrane 图书馆和 EMBASE 数据库，以确定 2000 年 1 月至 2018 年 2 月期间关于关节镜下肩袖修复术伴或不伴肩峰成形术的合格研究。提取术后功能结果、疼痛视觉模拟量表（VAS）和再次手术率进行系统分析。
符合选择标准的有 6 项随机对照试验（RCT）和 1 项队列研究（CS），共 651 例患者。结果显示，在最终随访时，肩袖撕裂伴或不伴肩峰成形术的美国肩肘外科医师（ASES）评分有显著差异，但 Constant 评分、加州大学洛杉矶分校（UCLA）评分或简单肩部测试（SST）评分无显著差异。在亚组分析中，最终随访时两种治疗方法的再次手术率或术后 6 个月和最终随访时的 VAS 评分无显著差异，但术后 12 个月的 VAS 评分有利于肩峰成形术治疗。每个结局的 GRADE 系统评价证据质量均为低。
总之，本研究表明，与肩袖修复术不伴肩峰成形术相比，肩峰成形术在术后 12 个月时的肩部疼痛缓解和最终随访时的 ASES 评分改善方面具有显著优势。然而，这些显著差异并无临床意义。因此，肩袖修复术伴或不伴肩峰成形术患者的肩部功能和疼痛评分无差异。需要进一步开展高质量、大样本量和长期随访的研究来阐明这一问题。
