目的:肩袖撕裂是一种常见的肩关节损伤,常导致日常生活中的严重限制。在这里,使用频率理论进行了网络荟萃分析,以评估五种肩袖修复技术的临床结果,包括单排修复,双排修复,缝合桥修复,富血小板血浆疗法,和骨髓刺激,从而指导肩袖修复的临床决策。
方法:PubMed,EMBase,科克伦图书馆,和WebofScience进行了随机对照试验和队列研究,比较了从开始到2022年5月发表的肩袖修复技术.使用软件STATA15.1和ReviewManager5.3进行组合分析和质量评估。
结果:最终共收录51篇,包括27项随机对照试验和24项队列研究。网络荟萃分析结果显示:(1)在美国肩肘外科医师评分方面,富血小板血浆疗法,双排修复,骨髓刺激,单排修复明显优于缝合桥修复。(2)就恒定分数而言,骨髓刺激明显优于双排修复,单排修复,和缝合桥修复。(3)在视觉模拟量表评分方面,富血小板血浆治疗明显优于双排修复和缝合桥修复.(4)就加州大学洛杉矶分校的肩膀评定量表得分而言,富血小板血浆治疗和双排修复相对较好,但与其他治疗无显著差异.(5)在重新撕裂的风险方面,富血小板血浆治疗和双排修复的再撕裂率明显低于单排修复和缝合桥修复.
结论:基于网络Meta分析结果和表面下的累积排名,富血小板血浆疗法,骨髓刺激,双排修复具有良好的整体康复效果。建议根据临床实际情况选择合适的修复技术。
OBJECTIVE: Rotator cuff tear is a common shoulder injury that often leads to serious limitations in daily life. Herein, a network Meta-analysis using frequency theory was performed to evaluate the clinical outcomes of five rotator cuff repair techniques, including single-row repair, double-row repair, suture bridge repair, platelet-rich plasma therapy, and bone marrow stimulation, thus guiding clinical decision-making on rotator cuff repair.
METHODS: PubMed, EMbase, The Cochrane Library, and Web of Science were searched for randomized controlled trials and cohort studies comparing rotator cuff repair techniques published from inception to May 2022. Combined analysis and quality assessment were performed using software STATA15.1 and Review Manager5.3.
RESULTS: A total of 51 articles were finally included, including 27 randomized controlled trials and 24 cohort studies. Results from the network Meta-analysis showed that: (1) In terms of the American Shoulder and Elbow Surgeons score, platelet-rich plasma therapy, double-row repair, bone marrow stimulation, and single-row repair were significantly better than suture bridge repair. (2) In terms of Constant score, bone marrow stimulation was significantly better than double-row repair, single-row repair, and suture bridge repair. (3) In terms of visual analog scale score, platelet-rich plasma therapy was significantly better than double-row repair and suture bridge repair. (4) In terms of the Shoulder Rating Scale of the University of California at Los Angeles score, platelet-rich plasma therapy and double-row repair were relatively better but not significantly different from the other treatments. (5) In terms of the risk of re-tear, the re-tear rate of platelet-rich plasma therapy and double-row repair was significantly lower than that of single-row repair and suture bridge repair.
CONCLUSIONS: Based on the results of network Meta-analysis and surface under the cumulative ranking, platelet-rich plasma therapy, bone marrow stimulation, and double-row repair have good overall rehabilitation effects. It is recommended to choose appropriate repair techniques as per the actual clinical situation.