■发展了背阔肌转移(LDT)和胸大肌转移(PMT)来治疗无法修复的肩胛骨下肌腱撕裂(ISScT);但是,其结局差异尚不清楚.
■系统地回顾和比较LDT和PMT对ISScT的结果。
■系统评价;证据水平,4.
■通过对Embase的全面搜索进行了系统评价,PubMed,还有Cochrane图书馆.根据纳入和排除标准纳入LDT或PMT的研究。主要结果是最终随访时的Constant-Murley评分(CMS)。次要结局包括主观肩峰值(SSV),疼痛视觉模拟量表(VAS)评分,活动的肩膀范围,和腹部按压和抬离测试。术后失败和并发症发生率是安全的结局指标。结果被总结为LDT和PMT组,结果进行统计学比较(P<0.05)。
■本综述包括12项研究:PMT组9项研究中的184个肩关节,LDT组3项研究中的85个肩关节。对于PMT和LDT组,平均年龄分别为58.9岁和55.1岁,分别,平均随访时间为66.9个月和17.4个月,分别。总的来说,LDT和PMT组在主要结局(CMS)和次要结局(SSV,VAS,ROM,和腹部按压和抬离测试),低的失败率和并发症。与PMT组相比,LDT组在CMS方面表现出更显著的改善(35.2vs24.7;P<.001),主动前屈(44.3°vs14.7°;P<.001),外展(35.0°对17.6°;P<.002),腹部按压试验阳性率(45%vs27%;P<.001)。术后失败率组间差异无统计学意义,并发症发生率,主动内旋转的平均改进,VAS,或SSV。
■一般来说,LDT术后的临床结果明显优于PMT。现有的公平质量证据表明,LDT可能是ISScT的更好选择。需要进一步评估两种手术方法的相对益处,更多高质量的随机对照研究。
UNASSIGNED: Latissimus dorsi transfer (LDT) and pectoralis major transfer (PMT) were developed to treat an irreparable subscapularis tendon tear (ISScT); however, the difference in their outcomes remains unclear.
UNASSIGNED: To systematically review and compare the outcomes of LDT and PMT for ISScT.
UNASSIGNED: Systematic review; Level of evidence, 4.
UNASSIGNED: A systematic review was performed through a comprehensive search of Embase, PubMed, and the Cochrane Library. Studies of LDT or PMT were included according to the inclusion and exclusion criteria. The primary outcome was the Constant-Murley score (CMS) at the final follow-up. Secondary outcomes included the subjective shoulder value (SSV), visual analog scale (VAS) score for pain, active shoulder range of motion, and the belly-press and lift-off tests. Postoperative failure and complication rates were the safety outcome measures. Outcomes were summarized into the LDT and PMT groups, and results were compared statistically (P < .05).
UNASSIGNED: Twelve studies were included in this review: 184 shoulders from 9 studies for the PMT group and 85 shoulders from 3 studies for the LDT group. For the PMT and LDT groups, the mean ages were 58.9 and 55.1 years, respectively, and the mean follow-up was 66.9 and 17.4 months, respectively. Overall, the LDT and PMT groups improved in the primary outcome (CMS) and secondary outcomes (SSV, VAS, ROM, and belly-press and lift-off tests), with low rates of failure and complication. When compared with the PMT group, the LDT group showed more significant improvements in CMS (35.2 vs 24.7; P < .001), active forward flexion (44.3° vs 14.7°; P < .001), abduction (35.0° vs 17.6°; P < .002), and positive belly-press test rate (45% vs 27%; P < .001). No statistically significant difference was seen between the groups in postoperative failure rate, complication rate, mean improvement of active internal rotation, VAS, or SSV.
UNASSIGNED: In general, LDT showed significantly better clinical outcomes postoperatively than did PMT. The available fair-quality evidence suggested that LDT might be a better choice for ISScT. Further evaluations on the relative benefits of the 2 surgical approaches are required, with more high-quality randomized controlled studies.