■大约90%接受关节镜肩袖修复(RCR)的患者对手术后的疼痛程度和功能感到满意。然而,一部分患者出现持续症状,需要进行翻修手术.需要进行翻修手术的RCR失败的术前风险因素尚未明确定义。
■为了(1)确定需要进行翻修手术的RCR失败率和(2)确定翻修手术的风险因素,这将有助于外科医生确定RCR失败风险最大的患者。
■系统评价和荟萃分析;证据水平,4.
■根据PRISMA(系统评价和荟萃分析的首选报告项目)指南进行系统评价和荟萃分析。最初的搜索结果是3158个标题,对533篇全文文章进行了资格评估。共有10项研究符合以下纳入标准:(1)人体临床研究,(2)关节镜下RCR,(3)原创性临床研究,(4)评估术前翻修的危险因素。
■经过全文审查,在10项研究中,共记录并分析了16个危险因素.皮质类固醇注射是翻修手术最一致的危险因素,在4项研究中的4项达到统计学意义,其次是工人的补偿状况(2/3的研究)。接受皮质类固醇注射的患者进行翻修手术的风险增加了47%(比值比,1.44[95%CI,1.36-1.52])。有工人补偿的患者有合并的翻修手术风险增加133%(比值比,2.33[95%CI,2.09-2.60])。年龄,吸烟状况,糖尿病,在一半的分析研究中,肥胖被发现是危险因素。
■皮质类固醇注射液,无论注射频率如何,根据定性分析和汇总分析,在文献中发现工人的薪酬状况是显著的风险因素。外科医生应通过考虑皮质类固醇注射史来确定关节镜RCR的理想人选。不管频率如何,以及患者的保险状况。
UNASSIGNED: Approximately 90% of patients who undergo arthroscopic rotator cuff repair (RCR) are satisfied with their pain levels and function after surgery. However, a subset of patients experience continued symptoms that warrant revision surgery. Preoperative risk factors for RCR failure requiring revision surgery have not been clearly defined.
UNASSIGNED: To (1) determine the rate of RCR failure requiring revision surgery and (2) identify risk factors for revision surgery, which will help surgeons to determine patients who are at the greatest risk for RCR failure.
UNASSIGNED: Systematic
review and meta-analysis; Level of evidence, 4.
UNASSIGNED: A systematic
review and meta-analysis in accordance with PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines were performed. The initial search resulted in 3158 titles, and 533 full-text articles were assessed for eligibility. A total of 10 studies met the following inclusion criteria: (1) human clinical studies, (2) arthroscopic RCR, (3) original clinical research, and (4) evaluation of preoperative risk factors for revision.
UNASSIGNED: After a full-text
review, a total of 16 risk factors were recorded and analyzed across 10 studies. Corticosteroid injection was the most consistent risk factor for revision surgery, reaching statistical significance in 4 of 4 studies, followed by workers\' compensation status (2/3 studies). Patients with corticosteroid injections had a pooled increased risk of revision surgery by 47% (odds ratio, 1.44 [95% CI, 1.36-1.52]). Patients with workers\' compensation had a pooled increased risk of revision surgery by 133% (odds ratio, 2.33 [95% CI, 2.09-2.60]). Age, smoking status, diabetes, and obesity were found to be risk factors in half of the analyzed studies.
UNASSIGNED: Corticosteroid injections, regardless of the frequency of injections, and workers\' compensation status were found to be significant risk factors across the literature based on qualitative analysis and pooled analysis. Surgeons should determine ideal candidates for arthroscopic RCR by accounting for corticosteroid injection history, regardless of the frequency, and insurance status of the patient.