Tufts University School of Medicine, Boston, MA, USA.
The Steadman Philippon Research Institute, Vail, CO, USA.
J ISAKOS. 2022 Dec;7(6):181-188. doi: 10.1016/j.jisako.2022.05.001. Epub 2022 May 18.
Repair of the subscapularis can be effective in the setting of reverse total shoulder arthroplasty (rTSA). However, there has yet to be a consensus on an optimal repair technique.
The purpose of this systematic review is to consolidate current high-quality studies comparing outcomes after rTSA with different subscapularis repair techniques.
A comprehensive literature review was conducted according to the preferred reporting items for systematic reviews and meta-Analyses using the PubMed, Embase, Scopus and Cochrane databases for original, English-language studies observing outcomes of rTSA after subscapularis repair published between January 1, 2000 and December 31, 2020. Subscapularis management techniques were repair to (1) tendon (tendon-tendon), (2) prosthetic stem, (3) lesser tuberosity (bone tunnels) or (4) a subscapularis-preserving approach (intact). The repair technique was recorded for included studies, and clinical and functional subjective scores were extracted from text, tables and figures. Forest plots were created to allow for qualitative comparison of the outcomes of interest between subscapularis repair techniques.
Seven comprehensive studies were identified, which included 367 patients. The mean age of patient at the time of surgery was 71.1 ± 2.8 years (range = 47-87 years). Overall, 259 patients underwent tendon-tendon repair, 48 patients underwent repair to prosthetic stem, 40 patients underwent repair with bone tunnels and 20 patients' subscapularis remained intact. Significant improvement was seen in most studies for Single Assessment Numeric Evaluation (range, Δ 42.6-Δ 46.0 out of 3), American Shoulder and Elbow Surgeons (range, Δ44.2-Δ43.6 out of 3) and Visual Analogue Scale pain scores (range Δ 4.2-Δ 6 out of 5). Active forward elevation (range Δ 40.4°-Δ 57.3° out of 4) and active external rotation (range Δ 2.9°-Δ 16.0° out of 4) significantly improved, but forward elevation varied by nearly 17° (Δ16.94°), while external rotation varied by 13° (Δ13.16°) among repair techniques. Complications were reported in only one study, which used a tendon-tendon technique.
This study summarizes the current evidence regarding subscapularis repair techniques after rTSA including functional and subjective clinical outcome scores. Several different subscapularis repair techniques during rTSA appear to lend to sufficient improvement in clinical and subjective outcomes. This information can help guide future studies in this area and highlights the need for high quality studies comparing different subscapularis repair techniques.
III.
在反式全肩关节置换术（rTSA）中，修复肩胛下肌是有效的。然而，对于最佳修复技术尚未达成共识。
本系统评价的目的是综合比较不同肩胛下肌修复技术后 rTSA 结果的现有高质量研究。
根据系统评价和荟萃分析的首选报告项目，使用 PubMed、Embase、Scopus 和 Cochrane 数据库，对 2000 年 1 月 1 日至 2020 年 12 月 31 日期间发表的关于 rTSA 后肩胛下肌修复的观察性、英文原始研究进行了全面的文献回顾。肩胛下肌管理技术包括修复至（1）肌腱（肌腱-肌腱）、（2）假体柄、（3）小结节（骨隧道）或（4）保留肩胛下肌的方法（完整）。记录了纳入研究的修复技术，并从文本、表格和图形中提取了临床和功能主观评分。创建了森林图，以允许对不同肩胛下肌修复技术的结果进行定性比较。
确定了 7 项全面的研究，其中包括 367 名患者。手术时患者的平均年龄为 71.1±2.8 岁（范围为 47-87 岁）。总体而言，259 名患者接受了肌腱-肌腱修复，48 名患者接受了假体柄修复，40 名患者接受了骨隧道修复，20 名患者的肩胛下肌保持完整。大多数研究中都观察到了单评估数字评估（范围为 3 分中的 42.6-46.0 分）、美国肩肘外科医生（范围为 3 分中的 44.2-43.6 分）和视觉模拟评分疼痛（范围为 5 分中的 4.2-6 分）显著改善。主动前向抬高（范围为 4 分中的 40.4°-57.3°）和主动外旋（范围为 4 分中的 2.9°-16.0°）明显改善，但外旋角度变化近 17°（Δ16.94°），而外旋角度变化 13°（Δ13.16°）在修复技术之间。仅在一项使用肌腱-肌腱技术的研究中报告了并发症。
本研究总结了目前关于 rTSA 后肩胛下肌修复技术的证据，包括功能和主观临床结局评分。几种不同的 rTSA 期间的肩胛下肌修复技术似乎可以改善临床和主观结局。这些信息可以帮助指导该领域的未来研究，并强调需要高质量的研究来比较不同的肩胛下肌修复技术。
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