在初次肩袖修复前或后进行皮质类固醇注射是否会影响不良事件的发生率？一项主观综合分析。
Do Corticosteroid Injections Before or After Primary Rotator Cuff Repair Influence the Incidence of Adverse Events? A Subjective Synthesis.
机构信息
Department of Orthopaedic Surgery, Division of Sports Medicine, Rush University Medical Center, Chicago, Illinois.
Department of Orthopaedic Surgery, Kaiser Permanente, Baldwin Park, California, U.S.A.
出版信息
Arthroscopy. 2020 May;36(5):1476-1484. doi: 10.1016/j.arthro.2020.01.039. Epub 2020 Feb 5.
PURPOSE
To determine the influence of corticosteroid injections (CSIs) before or after primary rotator cuff repair (RCR) on the risk of (1) revision RCR, (2) retears, and (3) infections.
METHODS
The Cochrane Database of Systematic Reviews, Cochrane Central Register of Controlled Trials, PubMed, Embase, and MEDLINE databases were queried in accordance with the 2009 Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) statement. Data pertaining to the use of CSIs before or after primary RCR and adverse events were extracted. A subjective synthesis of these outcomes and bias was performed.
RESULTS
A total of 10 studies including 240,976 patients were identified; 20.0% received a perioperative CSI. Of the 48,235 patients who received a CSI, 66.2% did so preoperatively whereas 33.8% did so postoperatively. A total of 78 patients received both preoperative and postoperative CSIs. Three studies examined the influence of preoperative CSIs on revision RCR; the incidence ranged from 3.8% to 10.5% with preoperative CSIs and from 3.2% to 3.4% for controls. Two of these studies analyzed outcomes of patients from the same databases over the same period. Five studies examined the influence of postoperative CSI use on retears; the incidence ranged from 5.7% to 19.0% in patients who received postoperative CSIs and from 10.0% to 18.4% for controls. Three studies examined the influence of CSI use on infection; 2 studies examined the risk of infection after postoperative CSI use, which ranged from 0.0% to 6.7% with CSIs and from 0.0% to 0.5% for controls.
CONCLUSIONS
The use of preoperative CSIs could be associated with an increased risk of revision RCR. There were no conclusive data to suggest an increased risk of retear or infection with CSI use based on a subjective synthesis of ranges. There is currently poor-quality literature surrounding this topic. Given that the current literature is limited and heterogeneous, no definitive recommendations can be made on perioperative CSI use for RCR.
LEVEL OF EVIDENCE
Level III, systematic review of Level I and III studies.
目的
确定在初次肩袖修复 (RCR) 前或后使用皮质类固醇注射 (CSI) 对 (1) 修复 RCR、(2) 再撕裂和 (3) 感染的风险的影响。
方法
根据 2009 年系统评价和荟萃分析 (PRISMA) 报告的首选报告项目，对 Cochrane 系统评价数据库、Cochrane 对照试验中心注册库、PubMed、Embase 和 MEDLINE 数据库进行了查询。提取了与初次 RCR 前或后使用 CSI 以及不良事件相关的数据。对这些结果和偏倚进行了主观综合分析。
结果
共确定了 10 项研究，共纳入 240976 名患者；20.0%的患者接受了围手术期 CSI。在接受 CSI 的 48235 名患者中，66.2%的患者术前接受了 CSI，33.8%的患者术后接受了 CSI。共有 78 名患者同时接受了术前和术后 CSI。三项研究探讨了术前 CSI 对修复 RCR 的影响；术前 CSI 的发生率为 3.8%至 10.5%，对照组为 3.2%至 3.4%。其中两项研究分析了来自同一数据库同一时期的患者的结果。五项研究探讨了术后 CSI 使用对再撕裂的影响；接受术后 CSI 的患者再撕裂的发生率为 5.7%至 19.0%，对照组为 10.0%至 18.4%。三项研究探讨了 CSI 使用对感染的影响；两项研究探讨了术后 CSI 使用后感染的风险，CSI 组的感染率为 0.0%至 6.7%，对照组为 0.0%至 0.5%。
结论
术前 CSI 的使用可能与修复 RCR 的风险增加有关。基于范围的主观综合分析，没有确凿的数据表明 CSI 使用与再撕裂或感染风险增加有关。目前针对这个话题的文献质量较差。鉴于目前的文献有限且存在异质性，因此不能对 RCR 围手术期 CSI 的使用做出明确的建议。
证据水平
三级，对一级和三级研究进行系统评价。
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