Surgery or conservative treatment for rotator cuff tear: a meta-analysis
Surgery or conservative treatment for rotator cuff tear: a meta-analysis
复制标题
DOI：
10.1080/09638288.2016.1198431
复制
发表时间：
2017-01-01
影响因子：
2.2
通讯作者：
Saltychev, Mikhail
中科院分区：
文献类型：
--
作者：
Ryosa, Anssi;Laimi, Katri;Saltychev, Mikhail
目的：治疗肩袖撕裂的比较证据尚不确定。本综述的目的是评估肌腱修复在减少疼痛和改善功能的肩部时，保守治疗症状性肩袖tear.Method：搜索中央，MEDLINE，EMBASE，CINAHL，Web的科学和佩德罗数据库的有效性的证据。比较肩袖撕裂手术和保守治疗的随机对照试验（RCT）。研究选择和提取基于干预措施系统评价的科克伦手册。随机效应荟萃分析。结果：三个确定的随机对照试验涉及252名参与者（123例和129对照）。认为所有3项RCT的偏倚风险均较低。对于Constant评分，1年随访中统计学不显著的效应量为5.6（95% CI -0.41至11.62）分，有利于手术，低于最小临床重要差异水平。在0-10疼痛视觉模拟量表上，疼痛减轻的相应差异为-0.93（95% CI -1.65至-0.21）cm，有利于手术。差异有统计学意义（p=0.012），在1年的后续行动，但低于最低水平的临床重要difference.Conclusion：有有限的证据表明，手术治疗肩袖撕裂比保守治疗更有效。因此，在本发明中，保守治疗被认为是最好的治疗方法。对康复的影响有限的证据表明，手术治疗肩袖撕裂并不比单纯保守治疗更有效。在1年的随访中，手术和积极的物理治疗之间没有显著的临床差异。在改善Constant评分或减少肩袖撕裂引起的疼痛方面有所提高。由于物理治疗不太容易出现并发症，而且比手术便宜，保守的方法被提倡作为肩袖撕裂的初始治疗方式。
Purpose: Comparative evidence on treating rotator cuff tear is inconclusive. The objective of this review was to evaluate the evidence on effectiveness of tendon repair in reducing pain and improving function of the shoulder when compared with conservative treatment of symptomatic rotator cuff tear.Method: Search on CENTRAL, MEDLINE, EMBASE, CINAHL, Web of Science and Pedro databases. Randomised controlled trials (RCT) comparing surgery and conservative treatment of rotator cuff tear. Study selection and extraction based on the Cochrane Handbook for Systematic reviews of Interventions. Random effects meta-analysis.Results: Three identified RCTs involved 252 participants (123 cases and 129 controls). The risk of bias was considered low for all three RCTs. For Constant score, statistically insignificant effect size was 5.6 (95% CI -0.41 to 11.62) points in 1-year follow up favouring surgery and below the level of minimal clinically important difference. The respective difference in pain reduction was -0.93 (95% CI -1.65 to -0.21) cm on a 0-10 pain visual analogue scale favouring surgery. The difference was statistically significant (p=0.012) in 1-year follow up but below the level of minimal clinically important difference.Conclusion: There is limited evidence that surgery is not more effective in treating rotator cuff tear than conservative treatment alone. Thus, a conservative approach is advocated as the initial treatment modality.Implications for RehabilitationThere is limited evidence that surgery is not more effective in treating rotator cuff tear than conservative treatment alone.There was no clinically significant difference between surgery and active physiotherapy in 1-year follow-up in improving Constant score or reducing pain caused by rotator cuff tear.As physiotherapy is less proneness to complications and less expensive than surgery, a conservative approach is advocated as the initial treatment modality to rotator cuff tears.