Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, Illinois, U.S.A.
Department of Orthopaedic Surgery, Washington University and Barnes-Jewish Orthopedic Center, Chesterfield, Missouri, U.S.A.
Arthroscopy. 2023 May;39(5):1310-1319.e2. doi: 10.1016/j.arthro.2023.01.003. Epub 2023 Jan 16.
To compare clinical and radiologic outcomes following superior capsular reconstruction (SCR) using dermal allograft versus tensor fascia lata (TFL) autograft for massive rotator cuff tears with a minimum 2-year follow-up.
A literature search was performed by querying Scopus, EMBASE, and PubMed computerized databases from database inception through September 2022 in accordance with the 2020 Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Studies evaluating clinical and radiologic outcomes, as well as complications following SCR for the treatment of massive rotator cuff tears were included. Study quality was assessed via the Newcastle-Ottawa Scale and the National Institutes of Health Quality Assessment. The mean change from preoperative to postoperative values (delta) was calculated for each outcome.
Seventeen studies, consisting of 519 patients were identified. Mean duration of follow-up ranged from 24 to 60 months. Mean reduction in visual analog scale pain score ranged from 2.9 to 5.9 points following use of dermal allograft, and 3.4 to 7.0 points following TFL autograft reconstruction. Mean improvements in American Shoulder and Elbow Surgeons score were similar between groups (dermal allograft: 28.0-61.6; TFL autograft: 24.7-59.3). The mean increase in forward flexion ranged from 31° to 38° with dermal allograft, versus 19° to 69° with TFL autograft. Average improvement in active external rotation with dermal allograft ranged from -0.4° to 11° and from 2° to 22.4° using TFL autograft. A similar change in acromiohumeral distance following SCR (dermal allograft: 0.9-3.2 mm; TFL autograft: 0.3-3.6 mm) was appreciated. The rate of complications within the dermal allograft group ranged from 4.5% to 38.2% versus 13.3% to 86.4% following TFL autograft. Failure rate ranged from 4.5 to 38.2% following dermal allograft versus 4.5 to 86.4% with TFL autograft.
Acellular dermal allograft versus TFL autograft for SCR both demonstrate improved VAS and American Shoulder and Elbow Surgeons scores, with increased values in flexion and external rotation, and increased visual analog scale, although with high variability. Both grafts demonstrate high rates of complications and failures at minimum 2-year follow-up.
IV; systematic review of level II-IV studies.
比较使用真皮移植物与阔筋膜张肌（TFL）自体移植物进行肩袖巨大撕裂的 Superior Capsular Reconstruction（SCR）后的临床和影像学结果，随访时间至少为 2 年。
根据 2020 年系统评价和荟萃分析的首选报告项目指南，通过查询 Scopus、EMBASE 和 PubMed 计算机数据库，对从数据库创建到 2022 年 9 月的文献进行了检索。纳入评估 SCR 治疗巨大肩袖撕裂的临床和影像学结果以及并发症的研究。通过纽卡斯尔-渥太华量表和美国国立卫生研究院质量评估对研究质量进行评估。计算每个结果从术前到术后的平均变化值（delta）。
确定了 17 项研究，共 519 名患者。随访时间平均为 24 至 60 个月。使用真皮移植物后，视觉模拟量表疼痛评分的平均降低幅度为 2.9 至 5.9 点，使用阔筋膜张肌自体移植物后为 3.4 至 7.0 点。两组间美国肩肘外科医生评分的平均改善相似（真皮移植物：28.0-61.6；阔筋膜张肌自体移植物：24.7-59.3）。使用真皮移植物时，前屈的平均增加幅度为 31°至 38°，而使用阔筋膜张肌自体移植物时为 19°至 69°。使用真皮移植物时，主动外旋的平均改善幅度为-0.4°至 11°，而使用阔筋膜张肌自体移植物时为 2°至 22.4°。在 SCR 后，肩峰肱骨头距离的变化也相似（真皮移植物：0.9-3.2mm；阔筋膜张肌自体移植物：0.3-3.6mm）。真皮移植物组的并发症发生率为 4.5%至 38.2%，而阔筋膜张肌自体移植物组为 13.3%至 86.4%。真皮移植物的失败率为 4.5%至 38.2%，而阔筋膜张肌自体移植物的失败率为 4.5%至 86.4%。
在肩袖巨大撕裂的 SCR 中，使用脱细胞真皮移植物与阔筋膜张肌自体移植物均可改善 VAS 和美国肩肘外科医生评分，且在前屈和外旋方面的数值增加，VAS 评分也增加，尽管存在高度变异性。两种移植物在至少 2 年的随访中均显示出高并发症和失败率。
IV；对 II-IV 级研究的系统评价。
