背景:对于不可修复的大量肩袖撕裂的治疗尚无共识。本系统评价和荟萃分析的目的是(1)比较患者报告的结果评分,(2)定义故障率和再操作率,(3)量化不同治疗策略的患者反应程度。
方法:MEDLINE,Embase,CENTRAL(Cochrane中央受控试验登记册),和Scopus数据库被搜索的研究包括物理治疗和手术治疗巨大的肩袖撕裂。使用非随机研究方法学指数的标准来评估研究质量。主要结果指标是患者报告的结果评分以及失败,并发症,和再操作率。为了量化患者对治疗的反应,我们比较了Constant-Murley评分和美国肩肘外科医师(ASES)评分与先前报道的最小临床重要差异(MCID)阈值的变化.
结果:没有发现符合纳入和排除标准的I级或II级研究。在纳入的患者中,物理疗法与30%的失败率相关,另有30%继续接受手术。部分修复与45%的再撕裂率和10%的再手术率相关。对于Constant-Murley评分和ASES评分,只有移植物插入与超过MCID的加权平均变化相关。使用肱骨骨隧道固定的背阔肌肌腱转移技术的失败率为77%。自体筋膜移植的上囊重建与ASES评分的加权平均变化超过MCID相关。反向关节成形术与10%的假体故障率和8%的再手术率相关。
结论:缺乏高质量的比较研究来指导治疗建议。与手术相比,物理治疗与感知功能结局改善较少相关,临床失败率较高.
BACKGROUND: There is no consensus on the treatment of irreparable massive rotator cuff tears. The goal of this systematic
review and meta-analysis was to (1) compare patient-reported outcome scores, (2) define failure and reoperation rates, and (3) quantify the magnitude of patient response across treatment strategies.
METHODS: The MEDLINE, Embase, CENTRAL (Cochrane Central Register of Controlled Trials), and Scopus databases were searched for studies including physical therapy and operative treatment of massive rotator cuff tears. The criteria of the Methodological Index for Non-randomized Studies were used to assess study quality. Primary outcome measures were patient-reported outcome scores as well as failure, complication, and reoperation rates. To quantify patient response to treatment, we compared changes in the Constant-Murley score and American Shoulder and Elbow Surgeons (ASES) score with previously reported minimal clinically important difference (MCID) thresholds.
RESULTS: No level I or II studies that met the inclusion and exclusion criteria were found. Physical therapy was associated with a 30% failure rate among the included patients, and another 30% went on to undergo surgery. Partial repair was associated with a 45% retear rate and 10% reoperation rate. Only graft interposition was associated with a weighted average change that exceeded the MCID for both the Constant-Murley score and ASES score. Latissimus tendon transfer techniques using humeral bone tunnel fixation were associated with a 77% failure rate. Superior capsular reconstruction with fascia lata autograft was associated with a weighted average change that exceeded the MCID for the ASES score. Reverse arthroplasty was associated with a 10% prosthesis failure rate and 8% reoperation rate.
CONCLUSIONS: There is a lack of high-quality comparative studies to guide treatment recommendations. Compared with surgery, physical therapy is associated with less improvement in perceived functional outcomes and a higher clinical failure rate.