肩袖修复术后注射皮质类固醇可改善功能、减轻疼痛且安全：一项系统评价
Corticosteroid Injections After Rotator Cuff Repair Improve Function, Reduce Pain, and Are Safe: A Systematic Review.
作者信息
Puzzitiello Richard N, Patel Bhavik H, Lavoie-Gagne Ophelie, Lu Yining, Nwachukwu Benedict U, Forsythe Brian, Salzler Matthew J
机构信息
Department of Orthopaedics, Tufts Medical Center, Boston, Massachusetts, U.S.A.
Department of Orthopaedic Surgery, University of Illinois, Chicago, Illinois, U.S.A.
出版信息
Arthrosc Sports Med Rehabil. 2021 Dec 20;4(2):e763-e774. doi: 10.1016/j.asmr.2021.10.010. eCollection 2022 Apr.
PURPOSE
To review the literature on postoperative corticosteroid injections (CSIs) following primary rotator cuff repair (RCR) to evaluate efficacy and adverse effects.
METHODS
A systematic review of the MEDLINE, EMBASE, and Cochrane databases were performed to identify all studies published within the last 15 years, which reported on outcomes of postoperative CSIs following RCR. Studies including patients who received only preoperative CSIs and revision RCRs were excluded. Included studies were evaluated for study methodology, patient demographics, outcome measures, physical examination parameters, results of imaging studies, and adverse effects or clinical complications.
RESULTS
Seven studies comprising 5,528 patients satisfied inclusion criteria. Among included patients, 54.8% were female and mean age range from 52.3 ± 13.0 to 62.7 ± 6.6 years. Only 1 included investigation was a Level I study. Overall, 4 of 5 studies reported significant improvements in pain and outcome scores (Constant score, American Shoulder and Elbow Surgeons score) compared with controls. Across all studies, the majority of these effects were statistically significant at 3 months postoperatively but not beyond this time point. Five of the 6 included investigations reported no increased rate of retears after postoperative CSIs. One study did find an increase in retear in patients receiving postoperative CSIs but was unable to determine whether these retears were present before the patient received the CSI. Another investigation reported an increased rate of infection only if the CSI was administered in the first postoperative month.
CONCLUSIONS
Postoperative CSIs may improve pain and function for up to 3 months following primary RCR but not at later follow-up time points. CSIs should be administered only after the first postoperative month to minimize the potential risk for adverse events.
LEVEL OF EVIDENCE
Systematic review of level I-IV studies.
目的
回顾关于初次肩袖修复术（RCR）后术后皮质类固醇注射（CSIs）的文献，以评估其疗效和不良反应。
方法
对MEDLINE、EMBASE和Cochrane数据库进行系统回顾，以识别过去15年内发表的所有报告RCR术后CSIs结果的研究。排除仅接受术前CSIs和翻修RCR的患者的研究。对纳入的研究进行研究方法、患者人口统计学、结局指标、体格检查参数、影像学研究结果以及不良反应或临床并发症的评估。
结果
七项研究共5528例患者符合纳入标准。纳入患者中，54.8%为女性，平均年龄范围为52.3±13.0至62.7±6.6岁。仅1项纳入研究为I级研究。总体而言，5项研究中有4项报告与对照组相比，疼痛和结局评分（Constant评分、美国肩肘外科医师评分）有显著改善。在所有研究中，这些效果大多在术后3个月具有统计学意义，但超过这个时间点则不然。6项纳入研究中有5项报告术后CSIs后再撕裂率没有增加。1项研究确实发现接受术后CSIs的患者再撕裂增加，但无法确定这些再撕裂是否在患者接受CSIs之前就已存在。另一项研究报告称，仅在术后第一个月进行CSIs时感染率会增加。
结论
初次RCR术后，术后CSIs可能在长达3个月内改善疼痛和功能，但在后期随访时间点则不然。CSIs应仅在术后第一个月后使用，以尽量减少不良事件的潜在风险。
证据级别
I-IV级研究的系统回顾。
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