关节镜下肩袖修复术后吊带与外展支具肩部固定的系统评价和Meta分析
Sling Versus Abduction Brace Shoulder Immobilization After Arthroscopic Rotator Cuff Repair: A Systematic Review and Meta-analysis.
作者信息
Gao Jing-Hui, Zhou Jing-Yi, Li Hong, Li Hong-Yun
机构信息
Department of Nursing, Huashan Hospital, Fudan University, Shanghai, China.
Department of Sports Medicine and Arthroscopic Surgery, Huashan Hospital, Fudan University, Shanghai, China.
出版信息
Orthop J Sports Med. 2023 Aug 1;11(8):23259671231185368. doi: 10.1177/23259671231185368. eCollection 2023 Aug.
BACKGROUND
The optimal immobilization position of the shoulder after rotator cuff repair is controversial.
PURPOSE
To compare the clinical outcomes and incidence of retears after arthroscopic rotator cuff repair between patients who used an abduction brace versus a sling for postoperative shoulder immobilization.
STUDY DESIGN
Systematic review; Level of evidence, 1.
METHODS
This systematic review and meta-analysis was conducted using PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines. We searched the PubMed, MEDLINE, and Embase electronic databases for randomized controlled trials (RCTs) that compared abduction brace and sling immobilization after arthroscopic rotator cuff repair using single-row, double-row, or suture-bridge fixation. Clinical scores, pain severity, and retear rates were compared between patients with abduction brace versus sling immobilization.
RESULTS
Of 1572 retrieved studies, 4 RCTs with a total of 224 patients (112 patients with abduction brace and 112 patients with sling) were included in the qualitative analysis, and 3 of the RCTs were included in the quantitative analysis (meta-analysis). There were no significant differences between the abduction brace and sling immobilization groups in the Constant-Murley score at 3 months (weighted mean difference [WMD], 0.26 [95% CI, -1.30 to 1.83]; = .74; = 84%), 6 months (WMD, 1.91 [95% CI, -0.17 to 4.00]; = .07; = 85%), and 12 months (WMD, 0.55 [95% CI, -1.37 to 2.47]; = .57; = 0%); the visual analog scale score for pain at 1 week (WMD, 0.10 [95% CI, -0.20 to 0.41]; = .51; = 0%), 3 weeks (WMD, -0.12 [95% CI, -0.34 to 1.00]; = .29; = 0%), 6 weeks (WMD, -0.12 [95% CI, -0.30 to 0.06]; = .20; = 0%), and 12 weeks (WMD, -0.13 [95% CI, -0.27 to 0.02]; = .09; = 18%); or the retear rate at 3 months (risk ratio, 0.63 [95% CI, 0.09 to 4.23]; = .64; = 0.47%) postoperatively.
CONCLUSION
Our systematic review demonstrated a lack of significant differences between the abduction brace and sling immobilization groups regarding postoperative clinical scores, pain severity, and tendon healing.
背景
肩袖修复术后肩部的最佳固定位置存在争议。
目的
比较使用外展支具与吊带进行术后肩部固定的患者在关节镜下肩袖修复术后的临床结果和再撕裂发生率。
研究设计
系统评价；证据等级，1级。
方法
本系统评价和荟萃分析按照PRISMA（系统评价和荟萃分析的首选报告项目）指南进行。我们在PubMed、MEDLINE和Embase电子数据库中检索了比较关节镜下肩袖修复术后使用单排、双排或缝线桥固定的外展支具与吊带固定的随机对照试验（RCT）。比较了使用外展支具与吊带固定的患者的临床评分、疼痛严重程度和再撕裂率。
结果
在检索到的1572项研究中，4项RCT（共224例患者，112例使用外展支具，112例使用吊带）纳入定性分析，3项RCT纳入定量分析（荟萃分析）。外展支具组与吊带固定组在3个月时的Constant-Murley评分（加权平均差[WMD]，0.26[95%CI，-1.30至1.83]；P = 0.74；I² = 84%）、6个月时（WMD，1.91[95%CI，-0.17至4.00]；P = 0.07；I² = 85%）和12个月时（WMD，0.55[95%CI，-1.37至2.47]；P = 0.57；I² = 0%）无显著差异；在1周时（WMD，0.10[95%CI，-0.20至0.41]；P = 0.51；I² = 0%）、3周时（WMD，-0.12[95%CI，-0.34至1.00]；P = 0.29；I² = 0%）、6周时（WMD，-0.12[95%CI，-0.30至0.06]；P = 0.20；I² = 0%）和12周时（WMD，-0.13[95%CI，-0.27至0.02]；P = 0.
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