Department of Orthopedics, Shaanxi Provincial People's Hospital, Shaanxi Province, China.
Department of Orthopedics, Shaanxi Provincial People's Hospital, Shaanxi Province, China.
J Shoulder Elbow Surg. 2023 Jul;32(7):1524-1533. doi: 10.1016/j.jse.2023.03.018. Epub 2023 Apr 20.
To date, no conclusions have been reached regarding the type of brace worn after arthroscopic rotator cuff repair. To this end, a systematic review and meta-analysis of randomized controlled trials (RCTs) were conducted.
According to the updated guidelines of the Preferred Reporting Items of Systematic Review and Meta-Analysis, all related literature in PubMed, Embase, and Cochrane Central Register of Controlled Trials, from their establishment to March 1, 2022, were searched systematically. Outcome measures included the Constant score, Western Ontario Rotator Cuff (WORC) index, visual analog scale (VAS) score, shoulder joint range of motion (ROM), and failure events of rotator cuff healing. The Cochrane risk of bias tool was used to evaluate the quality of RCT.
Two independent reviewers (Chen, Wu) reviewed 275 articles, of which only five met the inclusion criteria, and four were included in the meta-analysis, with a total of 302 patients. The overall risk of bias was high in two RCTs, unclear in one, and low in two. Considering the clinical outcomes, the Constant score (P = .08 mean deviation [MD], 3.06; 95% confidence interval [CI], -0.42 to 6.53), WORC (P = .23; MD, 3.32; 95%CI, -2.15 to 8.79), VAS score (P = .09; MD -1.27; 95%CI, -2.75 to 0.21), ROM (P = .1; MD, 4.75; 95%CI, -0.98 to 10.48), and failure events of rotator cuff healing (P = .78; odds ratio [OR], 0.86; 95%CI, 0.32 to 2.37) did not significantly differ between the abduction brace and simple sling after arthroscopic rotator cuff repair.
The findings of this systematic review and meta-analysis suggest that wearing abduction braces after rotator cuff repair neither improved the Constant score, VAS, and WORC scores, and ROM of the shoulder joint, nor did it reduce the risk of re-tearing. Therefore, a simple sling may be a better option in terms of cost effectiveness. It is expected that studies with larger and more homogeneous samples will help verify our results.
迄今为止，对于关节镜肩袖修复术后应佩戴哪种支具，尚无定论。为此，我们进行了一项系统评价和荟萃分析，纳入了随机对照试验（RCT）。
根据系统评价和荟萃分析首选报告项目的更新指南，系统检索了 PubMed、Embase 和 Cochrane 对照试验中心注册库自成立至 2022 年 3 月 1 日的所有相关文献。结局指标包括 Constant 评分、Western Ontario Rotator Cuff（WORC）指数、视觉模拟评分（VAS）、肩关节活动度（ROM）和肩袖愈合失败事件。采用 Cochrane 偏倚风险工具评价 RCT 质量。
两名独立 reviewer（Chen、Wu）对 275 篇文章进行了 review，其中只有 5 篇符合纳入标准，有 4 篇纳入荟萃分析，共纳入 302 例患者。2 项 RCT 的总体偏倚风险较高，1 项 RCT 的偏倚风险不明确，2 项 RCT 的偏倚风险较低。考虑临床结局，Constant 评分（P=0.08，MD=3.06；95%CI，-0.42 至 6.53）、WORC 评分（P=0.23；MD=3.32；95%CI，-2.15 至 8.79）、VAS 评分（P=0.09；MD=-1.27；95%CI，-2.75 至 0.21）、ROM（P=0.1；MD=4.75；95%CI，-0.98 至 10.48）和肩袖愈合失败事件（P=0.78；OR=0.86；95%CI，0.32 至 2.37）在关节镜肩袖修复术后佩戴外展支具与单纯吊带之间均无显著差异。
本系统评价和荟萃分析的结果表明，肩袖修复术后佩戴外展支具既不能改善 Constant 评分、VAS 和 WORC 评分以及肩关节 ROM，也不能降低再撕裂的风险。因此，从成本效益的角度来看，单纯吊带可能是更好的选择。预计更大、更同质的样本研究将有助于验证我们的结果。
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