Karasuyama Masaki, Gotoh Masafumi, Tahara Keiji, Kawakami Junichi, Madokoro Kazuya, Nagamatsu Takashi, Imai Takaki, Harada Nobuya, Kudo Yu, Shiba Naoto
Department of Physical Therapy, Kyushu Nutrition Welfare University, Kitakyushu, Japan.
Department of Orthopedic Surgery, Kurume University Medical Center, Kurume, Japan.
Clin Shoulder Elb. 2020 May 7;23(2):86-93. doi: 10.5397/cise.2020.00031. eCollection 2020 Jun.
Several systematic reviews have reported on the conservative treatment of full-thickness rotator cuff tears; however, clinical results of this treatment still remain determined.
PubMed, Cochrane Library, PEDro, and CINAHL databases were systematically searched for randomized clinical trials and observational studies. Two independent researchers reviewed a total of 2,981 articles, 28 of which met the criteria for inclusion in the study. Clinical outcome measures included Constant score, visual analog scale score for pain, range of motion, and short-form 36 questionnaires. The meta-analysis used a linear mixed model weighted with the variance of the estimate.
The meta-analysis showed a significant improvement after surgery. Pain score is 26.2 mm (1 month) to 26.4 mm (3 months), and 24.8 mm (12 months) (P<0.05); active abduction: 153.2º (2 months), 159.0º (6 months), 168.1º (12 months) (P<0.05); Constant score: 67.8 points (2 months) to 77.2 points (12 months) (P<0.05); short-form 36 questionnaires "vitality" section: 57.0 points (6 months) to 70.0 points (12 months) (P<0.05).
Our data confirmed the effectiveness of conservative treatment in patients with full-thickness rotator cuff tears 12 months post-intervention. The results suggest that conservative treatment for patients with full-thickness rotator cuff tears should be the first line of treatment before considering surgery.
多项系统评价报告了全层肩袖撕裂的保守治疗情况;然而,这种治疗的临床效果仍有待确定。
系统检索PubMed、Cochrane图书馆、PEDro和CINAHL数据库,查找随机临床试验和观察性研究。两名独立研究人员共审查了2981篇文章,其中28篇符合纳入该研究的标准。临床结局指标包括Constant评分、疼痛视觉模拟量表评分、活动范围和简明健康调查问卷。荟萃分析采用加权估计方差的线性混合模型。
荟萃分析显示术后有显著改善。疼痛评分在术后1个月为26.2mm,3个月为26.4mm,12个月为24.8mm(P<0.05);主动外展角度在术后2个月为153.2°,6个月为159.0°,12个月为168.1°(P<0.05);Constant评分在术后2个月为67.8分,12个月为77.2分(P<0.05);简明健康调查问卷“活力”部分评分在术后6个月为57.0分,12个月为70.0分(P<0.05)。
我们的数据证实了全层肩袖撕裂患者在干预后12个月进行保守治疗的有效性。结果表明,对于全层肩袖撕裂患者,在考虑手术之前,保守治疗应作为一线治疗方法。