Yang Lingdi, Zhang Jun, Ruan Dengfeng, Zhao Kun, Chen Xiao, Shen Weiliang
Department of Orthopedic Surgery of The Second Affiliated Hospital and Dr. Li Dak Sum & Yip Yio Chin Center for Stem Cell and Regenerative Medicine, Zhejiang University School of Medicine, Hangzhou, China.
Lishui People's Hospital, Lishui, China.
Orthop J Sports Med. 2020 Sep 17;8(9):2325967120948499. doi: 10.1177/2325967120948499. eCollection 2020 Sep.
The impact of diabetes on clinical and structural outcomes after rotator cuff repair remains controversial.
PURPOSE/HYPOTHESIS: The purpose of this study was to compare clinical outcomes and retear rates after rotator cuff repair in patients with and without diabetes. Our hypotheses were that adequate control of diabetes would decrease the retear rate after rotator cuff repair and that patients with diabetes would have worse clinical outcomes.
Systematic review; Level of evidence, 3.
The PubMed, Embase, and Cochrane Library databases were searched for studies comparing outcomes in patients with and without diabetes after full-thickness rotator cuff repair. Clinical outcome analysis included the Constant score, the American Shoulder and Elbow Surgeons (ASES) score, and the University of California-Los Angeles shoulder rating scale; we compared preoperative, postoperative, and change in functional scores from baseline to final follow-up among the included studies. The pooled relative risk was calculated using a random-effects model for retear rates. Clinical outcomes were also pooled using a random-effects model.
Overall, 10 studies were included. Compared with patients without diabetes, patients with diabetes had a worse preoperative ASES score ( = .009) as well as worse postoperative Constant score (final follow-up range, 9-103 months; = .0003). However, there was no significant difference in the absolute mean change in clinical outcomes between patients with and without diabetes. Diabetes was associated with a higher retear rate (19.3% in patients without diabetes vs 28.2% in patients with diabetes; < .0001). The retear rate according to the severity of sustained hyperglycemia in the subgroup analysis was 14.6% in patients without diabetes, versus 22.7% in patients with well-controlled diabetes (<7.0% of preoperative serum HbA1c level; = .12) and 40.0% in patients with uncontrolled diabetes (HbA1c level ≥7.0%; < .00001).
This meta-analysis suggests that diabetes mellitus is associated with an increased risk of retears after rotator cuff repair, and improved blood glucose control may reduce the risk of retears in patients with diabetes mellitus. Although effective glycemic control was associated with a decreased risk of retears in patients with diabetes, we could not prove causation because of potential bias and confounding in the included studies.
糖尿病对肩袖修复术后临床和结构结果的影响仍存在争议。
目的/假设：本研究的目的是比较糖尿病患者和非糖尿病患者肩袖修复术后的临床结果和再撕裂率。我们的假设是，充分控制糖尿病会降低肩袖修复术后的再撕裂率，且糖尿病患者的临床结果会更差。
系统评价；证据等级，3级。
检索PubMed、Embase和Cochrane图书馆数据库，以查找比较全层肩袖修复术后糖尿病患者和非糖尿病患者结局的研究。临床结局分析包括Constant评分、美国肩肘外科医师（ASES）评分和加州大学洛杉矶分校肩袖评分量表；我们比较了纳入研究中术前、术后以及从基线到最终随访的功能评分变化。使用随机效应模型计算再撕裂率的合并相对风险。临床结局也使用随机效应模型进行合并。
总体而言，纳入了10项研究。与非糖尿病患者相比，糖尿病患者术前ASES评分更差（P = 0.009），术后Constant评分也更差（最终随访范围为9 - 103个月；P = 0.0003）。然而，糖尿病患者和非糖尿病患者临床结局的绝对平均变化无显著差异。糖尿病与更高的再撕裂率相关（非糖尿病患者为19.3%，糖尿病患者为28.2%；P < 0.0001）。亚组分析中，根据持续性高血糖严重程度，非糖尿病患者的再撕裂率为14.6%，血糖控制良好的糖尿病患者（术前血清糖化血红蛋白水平<7.0%）为22.7%（P = 0.12），血糖控制不佳的糖尿病患者（糖化血红蛋白水平≥7.0%）为40.0%（P < 0.00001）。
这项荟萃分析表明，糖尿病与肩袖修复术后再撕裂风险增加相关，改善血糖控制可能降低糖尿病患者的再撕裂风险。尽管有效的血糖控制与糖尿病患者再撕裂风险降低相关，但由于纳入研究中存在潜在偏倚和混杂因素，我们无法证明因果关系。
