钟礼伦 卢耀鸣 林志东 郭达 徐逸生 牛维

摘 要 目的：系統评价一期关节镜手术对比二期手术治疗肩袖损伤合并关节僵硬的有效性及安全性。方法：通过计算机系统检索中国知网、万方资源数据、维普数据库、PubMed、Web of Science、The Cochrane Library和Embase数据库。查找相关的随机对照试验。进行文献质量评价并采用RevMan 5.3软件进行系统评价。结果：共纳入3篇研究，包括169例患者。由于纳入文献数量少且结局指标有差异，采用描述性系统评价。研究所纳入的3个研究显示末次随访时2组患者的关节活动度、美国肩肘外科协会评分量表（ASES）评分和视觉模拟量表（VAS）评分均较术前显著改善（P<0.05），且组间差异无统计学意义（P>0.05）。而在术后早期一期组活动度稍差于二期组。结论：一期手术组治疗肩袖损伤合并关节僵硬疗效确切，且与二期组相比，在末次随访时的活动度、ASES评分、VAS评分及肌力等方面无明显差异。然仍需要更多高质量研究来增强论证的强度。

关键词 肩袖损伤 关节僵硬 一期手术 二期手术 系统评价

中图分类号：R687.2； R686.1 文献标志码：A 文章编号：1006-1533（2021）07-0051-05

A systematic review of the effectiveness and safety of one-stage arthroscopic surgery in patients with rotator cuff injury and joint stiffness

ZHONG Lilun1*， LU Yaoming1， LIN Zhidong1， GUO Da2， XU Yisheng2， NIU Wei2**（1. the Second Clinical Medical College of Guangzhou University of TCM ， Guangzhou 510405， China； 2. Guangdong Province Hospital of TCM， Guangzhou 510120， China）

ABSTRACT Objective： To systematically evaluate the effectiveness and safety of primary arthroscopic surgery versus secondary surgery for rotator cuff injury combined with joint stiffness. Methods： Databases of CNKI， Wanfang Resources， VIP， PubMed， Web of Science， The Cochrane Library and Embase was retrieved and relevant randomized controlled trials were searched. Perform literature quality assessment and systematic review using RevMan 5.3 software. Results： A total of 3 studies（169 patients） were included. Due to the lack of literature and differences in outcome indicators， descriptive systematic evaluation was used. Three studies included in the study showed that joint mobility， the American Shoulder and Elbow Surgeons form（ASES） score， and visual analogue scale （VAS） score of the two groups at the last follow-up were significantly improved than before surgery （P<0.05）， and there were no significance differences between two groups （P>0.05）. In the early postoperative period， the activity of the first-stage group was slightly worse than that of the second-stage group. Conclusion： The efficacy of the first-stage surgery group in treating rotator cuff injury with joint stiffness is clear， and there is no significant difference in activity， ASES score， VAS score， and muscle strength at the last follow-up compared with the second-stage group. At the same time， However， more high-quality studies are still needed to enhance the strength of the argument.

KEy WORDS rotator cuff injury； joint stiffness； one-stage surgery； two-stage surgery； systematic evaluation

肩袖是由冈上肌、冈下肌、小圆肌和肩胛下肌组成的肌腱复合体，具有将肱骨头回纳入肩关节盂和协助肩关节外展的作用。肩袖损伤在临床上较为常见，文献[1]报道，通过尸体解剖发现70岁以上的死者中肩袖损伤的占比在90%～100%。90%的肩袖损伤为慢性损伤[2]，且肩袖损伤的范围与程度并不与肩关节疼痛成对应关系，肩袖损伤多表现为隐匿性、进行性关节疼痛和无力，故肩袖损伤的早期诊断存在一定的难度[3]。……