关节镜下肩袖修复术后支具类型对康复效果影响的Meta分析

Meta-Analysis of the Effect of Different Types of Braces on Rehabilitation after Arthro-scopic Rotator Cuff Repair

摘要: 背景：迄今为止，关于关节镜下肩袖修复术后应佩戴外展支具或肩带吊带还没有得出结论。为此，对随机对照试验进行了系统综述和Meta分析。方法：根据系统综述和Meta分析首选报告项目(PRISMA)的更新指南，系统搜索PubMed、Embase和Cochrane中央对照试验注册中心(Central)中从其建立到2022年3月1日的所有相关文献。结果评定包括恒定评分(Constant score)、西安大略肩袖(WORC)指数、视觉模拟量表(VAS)评分、肩关节活动范围(ROM)和肩袖愈合失败事件。Cochrane偏倚风险工具用于评价随机对照试验(RCT)的质量。结果：两位评价者(陈、刘)独立评价了275篇文章，其中只有5篇符合纳入标准，4篇纳入Meta分析，共302例患者。两项RCT中偏倚的总体风险较高，一项不明确，另两项较低。临床结果如下：常数评分(P = 0.08；MD，3.06；95%可信区间[CI]，−0.42~6.53)，WORC (P = 0.23; MD, 3.32; 95%CI, −2.15~8.79)，视觉模拟量表(VAS)评分(P = 0.09; MD, −1.27; 95%CI, −2.75~0.21)，ROM (P = 0.1; MD, 4.75; 95%CI, −0.98~10.48)，以及肩袖愈合失败事件(P = 0.78；比值比[OR]，0.86)；关节镜下肩袖修复后，外展支具和简单吊带之间没有显著差异。结论：这项系统综述和Meta分析的结果表明，肩袖修复后佩戴外展支具既不能改善肩关节的恒定评分、VAS评分、WORC评分和ROM，也不能降低肩袖再撕裂的风险。因此，从成本效益来看，简单吊带可能是更好的选择。预计使用更大更同质样本的研究将有助于验证我们的结果。

Abstract: Background: To date, no conclusions have been reached regarding the type of brace worn after ar-throscopic rotator cuff repair. To this end, a systematic review and meta-analysis of randomized controlled trials was conducted. Methods: According to the updated guidelines of the preferred re-porting items of systematic review and meta-analysis (PRISMA), all related literature in PubMed, Embase, and Cochrane Central Register of Controlled Trials (Central), from their establishment to March 1, 2022, were searched systematically. Outcome measures included the Constant score, Western Ontario Rotator Cuff (WORC) index, visual analog scale (VAS) score, shoulder joint range of motion (ROM), and failure events of rotator cuff healing. The Cochrane risk-of-bias tool was used to evaluate the quality of randomized controlled trials (RCT). Results: Two independent reviewers (Chen, Liu) reviewed 275 articles, of which only five met the inclusion criteria, and four were in-cluded in the meta-analysis, with a total of 302 patients. The overall risk of bias was high in two RCTs, unclear in one, and low in two. Considering the clinical outcomes, the Constant score (P = 0.08 MD, 3.06; 95% confidence interval [CI], −0.42 to 6.53), WORC (P = 0.23; MD, 3.32; 95%CI, −2.15 to 8.79) , visual analog scale (VAS) score (P = 0.09; MD −1.27; 95%CI, −2.75 to 0.21), ROM (P = 0.1; MD, 4.75; 95%CI, −0.98 to 10.48), and failure events of rotator cuff healing (P = 0.78; odds ratio [OR], 0.86; 95%CI, 0.32 to 2.37) did not significantly differ between the abduction brace and simple sling after arthroscopic rotator cuff repair. Conclusion: The findings of this systematic review and me-ta-analysis suggest that wearing abduction braces after rotator cuff repair neither improved the Constant score, VAS, and WORC scores, and ROM of the shoulder joint, nor did it reduce the risk of retearing. Therefore, a simple sling may be a better option in terms of cost-effectiveness. It is ex-pected that studies with larger and more homogeneous samples will help verify our results.