早期肩峰撞击综合征关节镜下肩峰减压术与非手术治疗效果比较的Meta分析

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摘要目的通过Meta分析的方法对关节镜下肩峰减压术与非手术治疗早期肩峰撞击综合征的有效性进行比较,以期为临床治疗肩峰撞击综合征提供循证依据。方法计算机检索PubMed、Embase、Cochrane图书馆、中国知网、万方等数据库(检索时间为建库至2021-05-02)中比较非手术治疗和关节镜下肩峰减压术治疗早期肩峰撞击综合征的临床随机对照研究,经过严格的质量评价后使用Review Manager 5.3软件进行Meta分析。评价指标为肩关节疼痛评分与肩关节功能评分,并将Meta分析结果分为短期随访组(<2年)与长期随访组(≥2年)进行亚组分析。结果共纳入7项临床随机对照研究,包含607例患者。Meta分析结果显示,关节镜下肩峰减压术与非手术治疗相比,功能评分在短期内(SMD= 0.12;95%CI:-0.18～0.43;P=0.42)和长期内(SMD=0.30;95%CI:-0.06～0.66;P=0.10)差异均无统计学意义;疼痛评分在短期内(SMD=-0.06;95%CI:-0.28～0.17;P=0.62)和长期内(SMD=-0.12;95% CI:-0.39～0.15;P=0.38)差异同样无统计学意义。结论治疗早期肩峰撞击综合征患者,关节镜下肩峰减压术与非手术治疗相比无明显优势,建议优先选择非手术治疗。

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	刘数敬
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关键词 ：关节镜下肩峰减压术, 非手术治疗, 肩峰撞击综合征, Meta分析

Abstract：Objective To compare the eficiency of arthroscopic decompression and non-surgical treatment for early stage shoulder impingement syndrome. Methods PubMed, Embase, Cochrane Library, CNKI, Wanfang and other databases were searched by computer (search time was from the establishment of the database to 2021-05-02) for clinical randomized controlled studies comparing non-surgical treatment with arthroscopic acromial decompression in the treatment of early acromial impaction syndrome. Meta-analysis was performed by using Review Manager 5.3 software after rigorous quality evaluation. The evaluation indexes were shoulder pain score and shoulder function score, and the results of meta-analysis were divided into short-term subgroup (<2 years) and long-term subgroup (≥2 years). Results Seven randomized controlled trials (RCTs) were included, involving a total of 607 patients. There were no significant differences in shoulder function scores between arthroscopic decompression and non-surgical treatment whether in long-term group(SMD=0.30;95%CI:－0.06--0.66;P=0.10) or short-term follow-up subgroup(SMD= 0.12;95%CI:－0.18-0.43;P=0.42). There were no significant differences in shoulder pain scores either whether in long-term group(SMD= －0.12;95% CI:－0.39-0.15;P=0.38) or short-term follow-up subgroup(SMD= －0.06;95%CI:－0.28-0.17;P=0.62). Conclusions No significant difference is demonstrated in the treatment of early stage shoulder impingement syndrome between arthroscopic decompression and non-surgical treatment in the Meta-analysis, thus non-surgical treatment should be chosen firstly for patients with early stage shoulder impingement syndrome.

收稿日期: 2022-03-20

ZTFLH:

R684.7

通讯作者: 王昊,E-mail:wanghaowj@126.com

作者简介: 刘数敬,硕士研究生,住院医师。

引用本文:

刘数敬, 喻瑛瑛, 路遥, 王波, 王昊. 早期肩峰撞击综合征关节镜下肩峰减压术与非手术治疗效果比较的Meta分析[J]. 武警医学, 2022, 33(10): 889-894. LIU Shujing, YU Yingying, LU Yao, WANG Bo, WANG Hao. Meta-analysis of arthroscopic decompression and non-surgical treatment for early stage shoulder impingement syndrome. Med. J. Chin. Peop. Armed Poli. Forc., 2022, 33(10): 889-894.

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http://journal08.magtechjournal.com/Jwk_wjyx/CN/ 或 http://journal08.magtechjournal.com/Jwk_wjyx/CN/Y2022/V33/I10/889

[1]	Neer C S, 2nd. Anterior acromioplasty for the chronic impingement syndrome in the shoulder: a preliminary report[J]. J Bone Joint Surg Am, 1972, 54(1): 41-50.
[2]	Ellman H, Kay S P. Arthroscopic subacromial decompression for chronic impingement. Two- to five-year results[J]. J Bone Joint Surg Br, 1991, 73(3): 395-398.
[3]	Beard D, Rees J, Rombach I, et al. The CSAW study (Can shoulder arthroscopy work?) - a placebo-controlled surgical intervention trial assessing the clinical and cost effectiveness of arthroscopic subacromial decompression for shoulder pain: study protocol for a randomised controlled trial[J]. Trials, 2015, 16: 210.
[4]	Paavola M, Malmivaara A, Taimela S, et al. Subacromial decompression versus diagnostic arthroscopy for shoulder impingement: randomised, placebo surgery controlled clinical trial[J]. BMJ, 2018, 362: k2860.
[5]	Peters G, Kohn D. Mid-term clinical results after surgical versus conservative treatment of subacromial impingement syndrome [J]. Unfallchirurg, 1997, 100(8): 623-629.
[6]	Paavola M, Malmivaara A, Taimela S, et al. Finnish Subacromial Impingement Arthroscopy Controlled Trial (FIMPACT): a protocol for a randomised trial comparing arthroscopic subacromial decompression and diagnostic arthroscopy (placebo control), with an exercise therapy control, in the treatment of shoulder impingement syndrome[J]. BMJ Open, 2017, 7(5): e014087.
[7]	Dorrestijn O, Stevens M, Diercks R L, et al. A new interdisciplinary treatment strategy versus usual medical care for the treatment of subacromial impingement syndrome: a randomized controlled trial[J]. BMC Musculoskelet Disord, 2007, 8: 15.
[8]	Bhattacharyya R, Edwards K, Wallace A W. Does arthroscopic sub-acromial decompression really work for sub-acromial impingement syndrome: a cohort study[J]. BMC Musculoskelet Disord, 2014, 15: 324.
[9]	Farfaras S, Sernert N, Hallstrom E, et al. Comparison of open acromioplasty, arthroscopic acromioplasty and physiotherapy in patients with subacromial impingement syndrome: a prospective randomised study[J]. Knee Surg Sports Traumatol Arthrosc, 2016, 24(7): 2181-2191.
[10]	Rahme H, Solem-Bertoft E, Westerberg C E, et al. The subacromial impingement syndrome. A study of results of treatment with special emphasis on predictive factors and pain-generating mechanisms[J]. Scand J Rehabil Med, 1998, 30(4): 253-262.
[11]	Henkus H E, de Witte P B, Nelissen R G, et al. Bursectomy compared with acromioplasty in the management of subacromial impingement syndrome: a prospective randomised study[J]. J Bone Joint Surg Br, 2009, 91(4): 504-510.
[12]	Kolk A, Thomassen B J W, Hund H, et al. Does acromioplasty result in favorable clinical and radiologic outcomes in the management of chronic subacromial pain syndrome? A double-blinded randomized clinical trial with 9 to 14 years'follow-up[J]. J Shoulder Elbow Surg, 2017, 26(8): 1407-1415.
[13]	Ketola S, Lehtinen J T, Arnala I. Arthroscopic decompression not recommended in the treatment of rotator cuff tendinopathy: a final review of a randomised controlled trial at a minimum follow-up of ten years[J]. Bone Joint J, 2017, 99-B(6): 799-805.
[14]	Ketola S, Lehtinen J, Rousi T, et al. No evidence of long-term benefits of arthroscopicacromioplasty in the treatment of shoulder impingement syndrome: five-year results of a randomised controlled trial[J]. Bone Joint Res, 2013, 2(7): 132-139.
[15]	Ketola S, Lehtinen J, Rousi T, et al. Which patients do not recover from shoulder impingement syndrome, either with operative treatment or with nonoperative treatment?[J]. Acta Orthop, 2015, 86(6): 641-646.
[16]	Ketola S, Lehtinen J, Elo P, et al. No difference in long-term development of rotator cuff rupture and muscle volumes in impingement patients with or without decompression[J]. Acta Orthop, 2016, 87(4): 351-355.
[17]	Ketola S, Lehtinen J, Arnala I, et al. Does arthroscopic acromioplasty provide any additional value in the treatment of shoulder impingement syndrome?: a two-year randomised controlled trial[J]. J Bone Joint Surg Br, 2009, 91(10): 1326-1334.
[18]	Haahr J P, Andersen J H. Exercises may be as efficient as subacromial decompression in patients with subacromial stage II impingement: 4-8 years follow-up in a prospective, randomized study[J]. Scand J Rheumatol, 2006, 35(3): 224-228.
[19]	Haahr J P, Ostergaard S, Dalsgaard J, et al. Exercises versus arthroscopic decompression in patients with subacromial impingement: a randomised, controlled study in 90 cases with a one year follow up[J]. Ann Rheum Dis, 2005, 64(5): 760-764.
[20]	Beard D J, Rees J L, Cook J A, et al. Arthroscopic subacromial decompression for subacromial shoulder pain (CSAW): a multicentre, pragmatic, parallel group, placebo-controlled, three-group, randomised surgical trial[J]. Lancet, 2018, 391(10118): 329-338.
[21]	Brox J I, Gjengedal E, Uppheim G, et al. Arthroscopic surgery versus supervised exercises in patients with rotator cuff disease (stage II impingement syndrome): a prospective, randomized, controlled study in 125 patients with a 2 1/2-year follow-up[J]. J Shoulder Elbow Surg, 1999, 8(2): 102-111.
[22]	Brox J I, Staff P H, Ljunggren A E, et al. Arthroscopic surgery compared with supervised exercises in patients with rotator cuff disease (stage II impingement syndrome)[J]. BMJ, 1993, 307(6909): 899-903.
[23]	Neer C S, 2nd. Impingement lesions[J]. Clin Orthop Relat Res, 1983, (173): 70-77.
[24]	van Der Windt D A, Koes B W, de Jong B A, et al. Shoulder disorders in general practice: incidence, patient characteristics, and management[J]. Ann Rheum Dis, 1995, 54(12): 959-964.
[25]	Beard D J, Rees J L, Cook J A, et al. Arthroscopic subacromial decompression for subacromial shoulder pain (CSAW): a multicentre, pragmatic, parallel group, placebo-controlled, three-group, randomised surgical trial[J]. Lancet, 2018, 391(10118): 329-338.
[26]	Saltychev M, Aarimaa V, Virolainen P, et al. Conservative treatment or surgery for shoulder impingement: systematic review and meta-analysis[J]. Disabil Rehabil, 2015, 37(1): 1-8.