文章摘要
于洋,温亮.早期康复与延迟康复对关节镜肩袖修补术后肩关节功能及肩袖愈合影响的Meta分析.骨科,2020,11(6):496-505
早期康复与延迟康复对关节镜肩袖修补术后肩关节功能及肩袖愈合影响的Meta分析
Early rehabilitation versus delayed rehabilitation on function and recovery of rotator cuff after arthroscopic rotator cuff repair: a Meta-analysis of randomized controlled trials
投稿时间:2020-08-27  
DOI:10.3969/j.issn.1674-8573.2020.06.007
中文关键词: 关节镜  肩袖修补术  早期康复  延迟康复  Meta分析
英文关键词: Arthroscopy  Rotator cuff repair  Early rehabilitation  Delayed rehabilitation  Meta-analysis
基金项目:
作者单位E-mail
于洋 首都医科大学附属北京朝阳医院骨科北京 100020  
温亮 首都医科大学附属北京朝阳医院骨科北京 100020 wenliang@ccmu.edu.cn 
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中文摘要:
      目的 比较关节镜肩袖修补术后早期康复与延迟康复对术后肩关节功能和肩袖愈合的影响。方法 计算机检索PubMed、Web of Science、Cochrane Library、中国知网(CNKI)、万方数据库、维普数据库,查找比较关节镜肩袖修补术后早期康复与延迟康复肩关节功能和肩袖愈合的随机对照试验(RCTs)。按照文献纳入和排除标准筛选文献,并提取两种康复方案病人术后的美国肩肘外科学会(American Shoulder and Elbow Surgeons, ASES)评分、Constant-Murley评分、简明肩关节功能测试(simple shoulder test, SST)评分、疼痛视觉模拟量表(visual analogue scale, VAS)评分、肩关节活动度、肩袖愈合情况等信息,采用Review Manager 5.3软件对数据进行分析,使用GRADE(Grades of Recommendation, Assessment, Development and Evaluation)证据质量评级方法评价证据质量。结果 共纳入10篇文献,均为RCTs,共929例研究对象,其中早期康复组473例,延迟康复组456例。Meta分析结果显示:早期康复组与延迟康复组术后6个月和12个月的ASES、Constant-Murley评分、SST评分、VAS评分差异均无统计学意义(P均>0.05)。早期康复组术后6个月的肩关节前屈活动度大于延迟康复组[MD=3.30,95% CI(0.15,6.45),P=0.04],外旋活动度大于延迟康复组[MD=2.44,95% CI(0.33,4.54),P=0.02];早期康复组术后12个月肩关节前屈活动度大于延迟康复组[MD=1.26,95% CI(0.31,2.22),P=0.009]。在肩袖愈合方面,两组差异无统计学意义(P>0.05)。结论 关节镜下肩袖修补术后,对比延迟康复,早期康复在术后恢复肩关节功能方面没有差别,但尽早开始康复训练可更好地改善术后早期(6个月)肩关节前屈及外旋活动度,以及术后长期(12个月)肩关节前屈活动度。早期康复与延迟康复对肩袖愈合情况没有明显影响。
英文摘要:
      Objective To compare the effect of early rehabilitation versus delayed rehabilitation on function and recovery of rotator cuff after arthroscopic rotator cuff repair. Methods The PubMed, Web of Science, Cochrane Library, China National Knowledge Infrastructure (CNKI), WANFANG Data, and VIP databases were systematically searched. Only randomized controlled trials (RCTs) comparing function and recovery of early rehabilitation versus delayed rehabilitation after arthroscopic rotator cuff repair were included. All references were reviewed according to the inclusion and exclusion criteria. Data such as American Shoulder and Elbow Surgeons scores (ASES), Constant-Murley scores, simple shoulder test (SST) scores, visual analog scale (VAS) scores, shoulder ROM and healing rate were extracted and quality of references was evaluated using Cochrane handbook. Review Manager 5.3 was used to analyze the data. Grades of Recommendation, Assessment, Development and Evaluation (GRADE) system were used to evaluate the quality of evidence. Results A total of 10 RCTs with 929 patients were enrolled in this study with 473 patients receiving early rehabilitation and 456 patients receiving delayed rehabilitation. Meta-analysis showed no significant difference in ASES score, Constant-Murley score, SST score, VAS score at 6th month and 12th month after surgery between early rehabilitation and delayed rehabilitation. Shoulder ROM of early rehabilitation was significantly greater than delayed rehabilitation at 6th month after surgery [MD=3.30, 95% CI (0.15, 6.45), P=0.04]. External rotation of early rehabilitation was significantly greater than delayed rehabilitation at 6th month after surgery [MD=2.44, 95% CI (0.33, 4.54), P=0.02]. Flexion ROM of early rehabilitation was significantly greater than delayed rehabilitation at 12th month after surgery [MD=1.26, 95% CI (0.31, 2.22), P=0.009]. There was no significant difference between early rehabilitation and delayed rehabilitation in healing rate (P>0.05). Conclusion There is no significant difference between early rehabilitation and delayed rehabilitation in shoulder function after arthroscopic rotator cuff repair. Early rehabilitation may improve flexion ROM at both 6th month and 12th month after surgery, so as the external rotation ROM at 6th month. There was no significant difference in healing rate between early rehabilitation versus delayed rehabilitation.
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