PDF(Pubmed)
Abstract：
OBJECTIVE: Frozen shoulder (FS) is a painful and debilitating condition affecting the shoulder joint. When patients fail to improve after conservative treatments, operative treatments including arthroscopic capsular release (ACR) and manipulation under anesthesia (MUA) are recommended. However, the comparison between these two interventions remains controversial. This study aimed to compare the efficacy and safety of ACR and MUA for refractory FS.
METHODS: A systematic review and meta-analysis was conducted following the Preferred Reporting Items for Systematic Review and Meta-analyses (PRISMA) guidelines. PubMed, EMBASE, Cochrane Library, and Web of Science were searched for eligible studies until December 10, 2023. Meta-analyses were conducted using Manager V.5.3.3. Pooled effect sizes were expressed as the weighted mean difference (WMD) or odds ratio (OR) with 95% confidence intervals (CIs).
RESULTS: A total of eight comparative studies with 768 patients were included. Compared with MUA, ACR had statistically better Δ VAS (WMD, -0.44; 95% CI, -0.71 to -0.18; I2 = 6%; p = 0.001) at over 12-month follow-up, which did not reach the minimal clinically important difference (MCID). Other outcomes regarding pain relief, function, and range of motion (ROM) improvements were not statistically different between the two groups at different follow-up timepoints. Compared with the MUA group, the ACR group had a significantly higher rate of severe complications (OR, 4.14; 95% CI, 1.01 to 16.94; I2 = 0%; p = 0.05), but comparable rates of mild complications and additional intervention.
CONCLUSIONS: In treating refractory FS, ACR demonstrated comparable pain relief, functional and ROM improvements, rates of mild complications and additional intervention but a higher risk of severe complications to MUA during short-term follow-up periods. Notably, ACR exhibited statistically superior improvement in the long-term pain relief compared to the MUA group, although it did not reach the MCID.
METHODS: A systematic review and meta-analysis was conducted following the Preferred Reporting Items for Systematic Review and Meta-analyses (PRISMA) guidelines. PubMed, EMBASE, Cochrane Library, and Web of Science were searched for eligible studies until December 10, 2023. Meta-analyses were conducted using Manager V.5.3.3. Pooled effect sizes were expressed as the weighted mean difference (WMD) or odds ratio (OR) with 95% confidence intervals (CIs).
RESULTS: A total of eight comparative studies with 768 patients were included. Compared with MUA, ACR had statistically better Δ VAS (WMD, -0.44; 95% CI, -0.71 to -0.18; I2 = 6%; p = 0.001) at over 12-month follow-up, which did not reach the minimal clinically important difference (MCID). Other outcomes regarding pain relief, function, and range of motion (ROM) improvements were not statistically different between the two groups at different follow-up timepoints. Compared with the MUA group, the ACR group had a significantly higher rate of severe complications (OR, 4.14; 95% CI, 1.01 to 16.94; I2 = 0%; p = 0.05), but comparable rates of mild complications and additional intervention.
CONCLUSIONS: In treating refractory FS, ACR demonstrated comparable pain relief, functional and ROM improvements, rates of mild complications and additional intervention but a higher risk of severe complications to MUA during short-term follow-up periods. Notably, ACR exhibited statistically superior improvement in the long-term pain relief compared to the MUA group, although it did not reach the MCID.
摘要：
目的：肩关节冻结（FS）是一种影响肩关节的疼痛和衰弱的疾病。当患者在保守治疗后未能好转时，手术治疗包括关节镜下关节囊松解术（ACR）和麻醉下操作（MUA）。然而,这两种干预措施之间的比较仍然存在争议.本研究旨在比较ACR和MUA治疗难治性FS的疗效和安全性。
方法：遵循系统评价和荟萃分析（PRISMA）指南的首选报告项目进行系统评价和荟萃分析。PubMed,EMBASE,科克伦图书馆,和WebofScience在2023年12月10日之前搜索了符合条件的研究。使用ManagerV.5.3.3进行荟萃分析。合并的效应大小表示为加权平均差（WMD）或比值比（OR），具有95％置信区间（CI）。
结果：共纳入了768例患者的8项比较研究。与MUA相比,ACR具有统计学上更好的ΔVAS(WMD，-0.44；95%CI，-0.71至-0.18；I2=6%；p=0.001）在12个月的随访中，未达到最小临床重要差异（MCID）。关于疼痛缓解的其他结果，函数,在不同的随访时间点,两组间的活动范围(ROM)改善无统计学差异.与MUA组相比，ACR组的严重并发症发生率明显较高(OR,4.14；95%CI，1.01至16.94；I2=0%；p=0.05），但轻度并发症和额外干预的发生率相当。
结论：在治疗难治性FS时，ACR表现出可比的疼痛缓解，功能和ROM的改进，轻度并发症和额外干预的发生率，但短期随访期间MUA严重并发症的风险更高。值得注意的是,与MUA组相比，ACR在长期疼痛缓解方面表现出统计学上的优越改善，虽然它没有达到MCID。
方法：遵循系统评价和荟萃分析（PRISMA）指南的首选报告项目进行系统评价和荟萃分析。PubMed,EMBASE,科克伦图书馆,和WebofScience在2023年12月10日之前搜索了符合条件的研究。使用ManagerV.5.3.3进行荟萃分析。合并的效应大小表示为加权平均差（WMD）或比值比（OR），具有95％置信区间（CI）。
结果：共纳入了768例患者的8项比较研究。与MUA相比,ACR具有统计学上更好的ΔVAS(WMD，-0.44；95%CI，-0.71至-0.18；I2=6%；p=0.001）在12个月的随访中，未达到最小临床重要差异（MCID）。关于疼痛缓解的其他结果，函数,在不同的随访时间点,两组间的活动范围(ROM)改善无统计学差异.与MUA组相比，ACR组的严重并发症发生率明显较高(OR,4.14；95%CI，1.01至16.94；I2=0%；p=0.05），但轻度并发症和额外干预的发生率相当。
结论：在治疗难治性FS时，ACR表现出可比的疼痛缓解，功能和ROM的改进，轻度并发症和额外干预的发生率，但短期随访期间MUA严重并发症的风险更高。值得注意的是,与MUA组相比，ACR在长期疼痛缓解方面表现出统计学上的优越改善，虽然它没有达到MCID。
