Conservative versus surgical management for patients with rotator cuff tears: a systematic review and META-analysis.
Conservative versus surgical management for patients with rotator cuff tears: a systematic review and META-analysis.
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DOI：
10.1186/s12891-020-03872-4
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发表时间：
2021-01-08
影响因子：
2.3
通讯作者：
Denaro V
中科院分区：
文献类型：
--
作者：
Longo UG;Risi Ambrogioni L;Candela V;Berton A;Carnevale A;Schena E;Denaro V
本研究旨在比较全层 RC 撕裂患者的保守治疗与手术治疗在 1 年和 2 年随访时的临床和结构结果。自每个数据库建立以来直至 2020 年 8 月，对 CENTRAL、MEDLINE、EMBASE、CINAHL、Google Scholar 和检索到的文章参考文献列表进行了全面检索。根据 Cochrane 干预系统评价手册，两位独立作者筛选了所有适合纳入的研究，提取数据并评估偏倚风险。仅纳入了比较成人全层 RC 撕裂的保守治疗和手术治疗的随机对照试验。主要结果指标是每种治疗在不同时间点的 Constant-Murley 评分 (CMS) 和 VAS 疼痛评分的有效性。次要结果是在不同时间点通过术后 MRI 评估修复肌腱的完整性。 GRADE 指南用于评估关键评估状态和证据质量。共有六篇文章符合纳入标准。随访12个月时手术组CMS评分平均值为77.6±14.4，保守组为72.8±16.5，组间差异无统计学意义。 24 个月的随访显示了类似的结果。随访12个月时，手术组VAS疼痛评分平均值为1.4±1.6，保守组为2.4±1.9。定量综合显示，在术后一年的 VAS 疼痛评分方面，手术组的结果更好（− 1.08，95% CI - 1.58 至 - 0.58；P < 0.001）。在两年的随访中，根据 CMS 评估的肩部功能并未显着改善。需要在长期随访中进行进一步的高质量 I 级随机对照试验，以评估手术治疗和保守治疗是否能提供可比较的长期结果。
This study aims to compare conservative versus surgical management for patients with full-thickness RC tear in terms of clinical and structural outcomes at 1 and 2 years of follow-up. A comprehensive search of CENTRAL, MEDLINE, EMBASE, CINAHL, Google Scholar and reference lists of retrieved articles was performed since the inception of each database until August 2020. According to the Cochrane Handbook for Systematic Reviews of Interventions, two independent authors screened all suitable studies for the inclusion, extracted data and assessed risk of bias. Only randomised controlled trials comparing conservative and surgical management of full-thickness RC tear in adults were included. The primary outcome measure was the effectiveness of each treatment in terms of Constant-Murley score (CMS) and VAS pain score at different time points. The secondary outcome was the integrity of the repaired tendon evaluated on postoperative MRI at different time points. The GRADE guidelines were used to assess the critical appraisal status and quality of evidence. A total of six articles met the inclusion criteria. The average value of CMS score at 12 months of follow-up was 77.6 ± 14.4 in the surgery group and 72.8 ± 16.5 in the conservative group, without statistically significant differences between the groups. Similar results were demonstrated at 24 months of follow-up. The mean of VAS pain score at 12 months of follow-up was 1.4 ± 1.6 in the surgery group and 2.4 ± 1.9 in the conservative group. Quantitative synthesis showed better results in favour of the surgical group in terms of VAS pain score one year after surgery (− 1.08, 95% CI − 1.58 to − 0.58; P < 0.001). At a 2-year follow-up, shoulder function evaluated in terms of CMS was not significantly improved. Further high-quality level-I randomised controlled trials at longer term follow-up are needed to evaluate whether surgical and conservative treatment provide comparable long-term results.
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影响因子：
15.8
作者：
Moher D;Liberati A;Tetzlaff J;Altman DG;PRISMA Group
通讯作者：
PRISMA Group
DOI：
10.1159/000328910
发表时间：
2012-01-01
期刊：
ROTATOR CUFF TEAR
影响因子：
--
作者：
Longo, Umile Giuseppe;Franceschi, Francesco;Denaro, Vincenzo
通讯作者：
Denaro, Vincenzo
影响因子：
3
作者：
Dunn, Warren R.;Kuhn, John E.;Wright, Rick W.
通讯作者：
Wright, Rick W.
影响因子：
5.3
作者：
Colvin, Alexis Chiang;Egorova, Natalia;Flatow, Evan L.
通讯作者：
Flatow, Evan L.
影响因子：
5.3
作者：
Moosmayer, Stefan;Lund, Gerty;Smith, Hans-Jorgen
通讯作者：
Smith, Hans-Jorgen