From the Division of Orthopaedic Surgery, The Ottawa Hospital, University of Ottawa, Ottawa, Ont. (Lapner); Department of Surgery, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ont. (Henry, Moktar); Roth|McFarlane Hand and Upper Limb Centre, St. Joseph's Health Care, Western University, London, Ont. (Athwal, McNeil); and Section of Orthopaedic Surgery & The Pan Am Clinic, University of Manitoba, Winnipeg, Man. (MacDonald)
From the Division of Orthopaedic Surgery, The Ottawa Hospital, University of Ottawa, Ottawa, Ont. (Lapner); Department of Surgery, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ont. (Henry, Moktar); Roth|McFarlane Hand and Upper Limb Centre, St. Joseph's Health Care, Western University, London, Ont. (Athwal, McNeil); and Section of Orthopaedic Surgery & The Pan Am Clinic, University of Manitoba, Winnipeg, Man. (MacDonald).
Can J Surg. 2023 Apr 21;66(2):E190-E195. doi: 10.1503/cjs.022221. Print 2023 Mar-Apr.
We sought to compare success and re-tear rates of surgically treated full-thickness tears of the rotator cuff in men and women older than 18 years of age to develop a guideline intended for orthopedic surgeons and other health care providers who assess, counsel and care for these patients. We searched Medline, Embase and Cochrane databases through to Apr. 20, 2021, and included all English-language randomized trials comparing single-row versus double-row fixation via arthroscopic approaches; latissimus dorsi transfer (LDT) versus partial rotator cuff repair, lower trapezius transfer (LTT), and superior capsular reconstruction (SCR); and early versus late arthroscopic rotator cuff repair for traumatic tears. We also considered observational studies comparing LDT with LTT and partial repair and studies comparing early versus late treatment of traumatic rotator cuff tears. Outcomes of interest were functional outcomes, pain outcomes, and re-tear rates associated with these interventions. We rated the quality of the evidence and strength of recommendations using the Grading of Recommendations, Assessment, Development, and Evaluation (GRADE) approach. This guideline will benefit patients seeking surgical intervention of full thickness rotator cuff tears by improving counselling on surgical treatment options and outcomes. It will also benefit surgical providers by expanding their knowledge of various surgical approaches. Data presented could be used to develop frameworks and tools for shared decision-making.
我们旨在比较 18 岁以上男性和女性全层肩袖撕裂患者的手术治疗成功率和再撕裂率，为评估、咨询和治疗这些患者的骨科医生和其他医疗保健提供者制定指南。我们检索了 Medline、Embase 和 Cochrane 数据库，检索时间截至 2021 年 4 月 20 日，纳入了所有比较关节镜下单排与双排固定、Latissimus dorsi 转移术（LDT）与部分肩袖修复术、下斜方肌转移术（LTT）和上囊重建术（SCR）、创伤性肩袖撕裂的早期与晚期关节镜修复的英语随机试验；还纳入了比较 LDT 与 LTT 和部分修复的观察性研究，以及比较创伤性肩袖撕裂的早期与晚期治疗的研究。我们关注的结局指标包括功能结局、疼痛结局和这些干预措施相关的再撕裂率。我们使用推荐评估、制定与评价（GRADE）方法对证据质量和推荐强度进行评级。本指南将通过改善对手术治疗选择和结局的咨询，使寻求全层肩袖撕裂手术干预的患者受益。它还将通过扩展各种手术方法的知识使外科医生受益。提出的数据可用于制定共享决策的框架和工具。
