Department of Orthopedics and Traumatology, Taipei Veterans General Hospital, Taipei, Taiwan; Department of Orthopedics, School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan; Department of Orthopedics and Traumatology, Taipei Veterans General Hospital Taitung Branch, Taitung, Taiwan.
Department of Physical Medicine and Rehabilitation, National Taiwan University College of Medicine, Taipei, Taiwan; Department of Physical Medicine and Rehabilitation, National Taiwan University Hospital, Bei-Hu Branch, Taipei, Taiwan.
J Shoulder Elbow Surg. 2022 Nov;31(11):2421-2430. doi: 10.1016/j.jse.2022.05.015. Epub 2022 Jun 20.
There is still a lack of consensus regarding whether suprascapular nerve decompression should be routinely performed with rotator cuff repair. Therefore, this meta-analysis aimed to evaluate whether additional suprascapular nerve release (SSNR) could improve shoulder functional outcomes and pain relief more than rotator cuff repair alone.
We performed a literature review of electronic databases for noncomparative and comparative studies investigating the effect of SSNR in patients undergoing rotator cuff repair. The primary outcome was the change in shoulder function scores from the preoperative status, and the secondary outcome was the change in the visual analog scale (VAS) score of pain after surgery. A subgroup analysis was conducted based on the study design (noncomparative studies vs. comparative studies).
Nine studies comprising 279 participants were included. Our analysis demonstrated that the group that underwent SSNR had a better shoulder functional score after surgery than at preoperative assessment (standardized mean difference [SMD], 1.333, 95% confidence interval [CI], 0.708-1.959). No significant differences were identified in shoulder function improvement between those with and without SSNR, with an SMD of 0.163 (95% CI, -0.091 to 0.418). Likewise, the group with SSNR showed a decreased VAS score after surgery compared to their preoperative status (SMD, 0.910; 95% CI, 0.560-1.260). However, there was no significant difference in VAS change between those with and without SSNR, with an SMD of 0.431 (95% CI, -0.095 to 0.956).
The present meta-analysis revealed that SSNR might not be routinely needed in rotator cuff tendon repair as no additional benefits in functional improvement or pain relief were identified compared to rotator cuff tendon repair alone.
目前对于在进行肩袖修复术时是否应常规行肩胛上神经减压术仍存在争议。因此,本荟萃分析旨在评估与单纯肩袖修复术相比,额外行肩胛上神经松解术(SSNR)是否能更好地改善肩部功能和缓解疼痛。
我们对电子数据库中的非对照和对照研究进行了文献回顾,以评估 SSNR 对行肩袖修复术患者的影响。主要结局是从术前状态开始的肩部功能评分变化,次要结局是术后疼痛视觉模拟评分(VAS)的变化。根据研究设计(非对照研究与对照研究)进行了亚组分析。
纳入了 9 项研究共 279 名参与者。我们的分析表明,行 SSNR 组术后肩部功能评分优于术前评估(标准化均数差 [SMD],1.333,95%置信区间 [CI],0.708-1.959)。有和没有 SSNR 的患者在肩部功能改善方面没有显著差异,SMD 为 0.163(95%CI,-0.091 至 0.418)。同样,行 SSNR 组术后 VAS 评分较术前降低(SMD,0.910;95%CI,0.560-1.260)。然而,有和没有 SSNR 的患者在 VAS 变化方面没有显著差异,SMD 为 0.431(95%CI,-0.095 至 0.956)。
本荟萃分析显示,与单纯肩袖修复术相比,SSNR 可能并非肩袖肌腱修复术的常规需要,因为在改善功能或缓解疼痛方面没有额外获益。