关节镜入路在肩胛下肌修复后并不优于开放手术：系统评价。
Arthroscopic approach does not yield better results than open surgery after subscapularis repair: a systematic review.
机构信息
II Clinica Ortopedica e Traumatologica, IRCCS Istituto Ortopedico Rizzoli, Via di Barbiano, 1/10 - c/o Lab Biomeccanica ed Innovazione Tecnologica, 40136, Bologna, Italy.
Unità Ortopedica Ospedale di Imola, Imola, Italy.
出版信息
Knee Surg Sports Traumatol Arthrosc. 2023 Jul;31(7):2688-2699. doi: 10.1007/s00167-023-07403-1. Epub 2023 Apr 1.
PURPOSE
This study aimed to compare the long-term outcomes of arthroscopic versus mini-open repair in patients with isolated subscapularis tendon tears.
METHODS
Google Scholar, PubMed, and Embase databases were searched for studies evaluating isolated subscapularis tears subsequently treated by arthroscopic or mini-open repair. The inclusion criteria were clinical studies reporting isolated subscapularis lesions treated by arthroscopic or mini-open repair, a minimum follow-up of 12 months, and clinical and functional outcomes reported in the study results. Articles not reporting functional outcomes or studies that reported results for anterosuperior rotator cuff tears without a separate analysis of subscapularis tendon tears were excluded. Studies older than 20 years and studies with a minimum follow-up of less than 12 months were also excluded.
RESULTS
A total of 12 studies met the inclusion criteria; 8 papers were included in the arthroscopic repair group, and 6 were included in the mini-open repair group (2 studies reported results for both techniques). The mean age reported was 49.3 years, and 85.1% of patients were male. The dominant limb was involved in 77.6% of the patients, and a traumatic onset of symptoms was verified in 76.3%. The mean time to surgery was 9.6 months. The Constant-Murley score showed positive results for the arthroscopic and mini-open groups, with mean postoperative values of 84.6 and 82.1, respectively. Promising results were also observed for pain, with a mean of 13.2 (out of 15) points for the arthroscopic group and 11.7 for the mini-open group. The long head of the biceps was involved in 78% of the patients, and LHB tenodesis or tenotomy were the most common concomitant procedures performed.
CONCLUSIONS
There was no significant difference in clinical and functional outcomes between open and arthroscopic repair. Moreover, the same complication rates were reported in both treatments, but arthroscopic repair led to less postoperative pain.
LEVEL OF EVIDENCE
IV.
目的
本研究旨在比较关节镜与小切口修复治疗孤立性肩胛下肌腱撕裂的长期疗效。
方法
在 Google Scholar、PubMed 和 Embase 数据库中检索评估孤立性肩胛下肌腱撕裂，随后行关节镜或小切口修复的研究。纳入标准为：临床研究报告孤立性肩胛下肌腱损伤，行关节镜或小切口修复，随访至少 12 个月，且研究结果中报告临床和功能结果；排除未报告功能结果的文章或仅报告肩袖前上侧撕裂结果，而未单独分析肩胛下肌腱撕裂的研究；排除 20 年以上的研究和随访时间少于 12 个月的研究。
结果
共纳入 12 项符合标准的研究；8 项研究纳入关节镜修复组，6 项研究纳入小切口修复组（2 项研究报告了两种技术的结果）。报道的平均年龄为 49.3 岁，85.1%的患者为男性。77.6%的患者为优势侧肢体受累，76.3%的患者有创伤性发病。手术时间的平均为 9.6 个月。关节镜和小切口组的 Constant-Murley 评分均为阳性，术后平均得分为 84.6 和 82.1。疼痛也观察到了良好的结果，关节镜组平均得分为 13.2（满分 15 分），小切口组为 11.7。肱二头肌长头肌腱受累占 78%，最常见的伴随手术为 LHB 腱固定或切断术。
结论
开放与关节镜修复在临床和功能结果方面无显著差异。此外，两种治疗方法报告的并发症发生率相同，但关节镜修复术后疼痛较轻。
证据等级
IV。
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