Yang Songyun, Pang Long, Zhang Chunsen, Wang Jiapeng, Yao Lei, Li Yinghao, Huang Yizhou, Tang Xin
Sports Medicine Center, West China Hospital, Sichuan University, Chengdu, People's Republic of China; Department of Orthopedics, Orthopedic Research Institute, West China Hospital, Sichuan University, Chengdu, People's Republic of China; Department of Orthopedics, People's Hospital of Santai County, Santai, People's Republic of China.
Sports Medicine Center, West China Hospital, Sichuan University, Chengdu, People's Republic of China; Department of Orthopedics, Orthopedic Research Institute, West China Hospital, Sichuan University, Chengdu, People's Republic of China.
Arthroscopy. 2025 May;41(5):1618-1634. doi: 10.1016/j.arthro.2024.05.026. Epub 2024 Jun 12.
To systematically assess the postoperative outcomes in patients undergoing arthroscopic rotator cuff repairs with or without concomitant acromioplasty through a rigorous systematic review of randomized controlled trials (RCTs).
This systematic review, following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines, aimed to identify RCTs comparing clinical outcomes of patients with full-thickness rotator cuff tears undergoing arthroscopic rotator cuff repair with acromioplasty versus those without at a minimum 12-month follow-up. Databases searched included PubMed, Web of Science, Embase, and the Cochrane Library. The risk of bias in the included studies was assessed using the revised Cochrane Risk of Bias 2. Meta-analysis was conducted for outcomes with at least 3 studies reporting, with pooled effect estimates calculated using either fixed-effect or random-effects models based on heterogeneity levels. Results were presented as the weighted mean difference or odds ratio with 95% confidence intervals (CIs). Primary outcomes included rates of retear and reoperation, whereas secondary outcomes included improvement in American Shoulder and Elbow Surgeons (ASES) score, range of motion (ROM), and complication rate.
Five high-quality RCTs, with low bias risk, involving 409 patients, revealed demographics of 58.4% males, mean age of 58.4 years, and the following acromion types: 12.2% type I, 70.7% type II, and 17.1% type III. Mean follow-up was 52.2 months. All involved studies reported comparable retear and complication rates between the 2 groups. However, the involved studies indicated a lower reoperation rate, and the pooled data demonstrated a statistically superior improvement in ASES score (weighted mean difference, 3.99; 95% CI, 1.00-6.99; P = .009) in the acromioplasty group. Both groups showed significant improvements in ROM, but insufficient data prevented a comparison.
Compared with arthroscopic rotator cuff repair alone, arthroscopic rotator cuff repair with acromioplasty demonstrated similar rates of retear and complications but had a significantly lower reoperation rate and superior improvement in ASES score. The available data were insufficient to draw a definitive conclusion regarding ROM. This conclusion is fragile due to a limited sample size.
Level II, systematic review of Level I and II studies.
通过对随机对照试验（RCT）进行严格的系统评价，系统评估接受或未接受同期肩峰成形术的关节镜下肩袖修补患者的术后结局。
本系统评价遵循系统评价和Meta分析的首选报告项目指南，旨在识别比较全层肩袖撕裂患者接受关节镜下肩袖修补并同期行肩峰成形术与未行肩峰成形术的患者临床结局的RCT，随访时间至少为12个月。检索的数据库包括PubMed、科学网、Embase和Cochrane图书馆。使用修订后的Cochrane偏倚风险2评估纳入研究的偏倚风险。对至少有3项研究报告的结局进行Meta分析，根据异质性水平使用固定效应或随机效应模型计算合并效应估计值。结果以加权平均差或比值比及95%置信区间（CI）表示。主要结局包括再撕裂率和再次手术率，次要结局包括美国肩肘外科医师学会（ASES）评分的改善、活动范围（ROM）和并发症发生率。
五项低偏倚风险的高质量RCT，涉及409例患者，显示男性占58.4%，平均年龄58.4岁，肩峰类型如下：I型占12.2%，II型占70.7%，III型占17.1%。平均随访时间为52.2个月。所有纳入研究均报告两组间再撕裂率和并发症发生率相当。然而，纳入研究表明再次手术率较低，汇总数据显示肩峰成形术组ASES评分改善在统计学上更优（加权平均差，3.99；95%CI，1.00 - 6.99；P = .009）。两组ROM均有显著改善，但数据不足无法进行比较。
与单纯关节镜下肩袖修补相比，关节镜下肩袖修补并同期行肩峰成形术显示出相似的再撕裂率和并发症发生率，但再次手术率显著较低，ASES评分改善更优。现有数据不足以就ROM得出明确结论。由于样本量有限，该结论并不稳固。
II级，对I级和II级研究的系统评价。
