目的 比较肱二头肌长头腱固定术(biceps tenodesis,BT)与盂唇修复术(labral repair,LR)在治疗单纯肩关节上盂唇前后向损伤(superior labral anterior posterior lesion,SLAP)中的疗效和潜在风险。方法 基于PubMed、Embase、中国知网、万方、维普、Web of Science和Cochrane Library数据库,检索建库至 2020-10-19的文献,根据预先确定的纳入和排除标准对文献进行筛选,采用Stata 14.0软件进行Meta分析,TSA 0.9.5.10 Beta 软件进行试验序贯分析。结果 共纳入7项研究,涉及279例患者,其中LR组148例,BT组131例。Meta分析结果显示:BT组的患者满意率(OR=0.29,95%CI:0.11~ 0.76)和重返运动率(OR=0.32,95%CI:0.15~0.71)显著高于LR组,美国肩肘外科医师评分(WMD=-0.34,95% CI:-9.59~2.79),加州大学洛杉矶分校评分(WMD=-1.94,95%CI:-5.58~1.70),视觉模拟量表评分(WMD=-0.73,95% CI:-2.01~0.54),并发症发生率(OR= 1.71,95% CI:0.56~5.22)和再手术率(OR=0.98,95%CI:0.33~2.90)两组差异无统计学意义。试验序贯分析表明,患者满意率累积纳入的研究穿过了传统界值和序贯分析界值,表明BT组可提升患者满意率的证据是充分的,而重返运动率累积纳入的研究穿过了传统界值,未穿过序贯分析界值,表明BT组提升重返运动率的证据尚不充分。结论 BT组的患者满意率优于LR组,且具有一定的安全性,但仍需纳入更多高质量的随机对照试验进一步验证。

Objective To evaluate the efficacy and possible risks of biceps tenodesis (BT) and labral repair (LR) in the treatment of isolated SLAP lesions.Methods PubMed, Embase, CNKI, WanFang Data, VIP Database, Web of Science and Cochrane Library were searched for related literature that was published from inception to October 19, 2020. The studies selected were screened according to the predefined inclusion and exclusion criteria. Meta-analysis was performed using Stata 14, while TSA 0.9.5.10 Beta software was used for trial sequential analysis.Results Seven studies involving 279 patients were included,with 148 in the LR group and 131 in the BT group. The results of meta-analysis showed that the patients' level of satisfaction (OR=0.29,95%CI:0.11-0.76) and the number of patients who resumed activity (OR=0.32,95%CI:0.15-0.71) in the BT group were significantly higher than those of the LR group. There was no significant difference in the American Shoulder and Elbow Surgeons score (WMD=-0.34,95% CI:-9.59-2.79), the University of California at Los Angeles score (WMD=-1.94,95%CI:-5.58-1.70), visual analogue scale (WMD=-0.73,95%CI:-2.01-0.54), the incidence of complications (OR=1.71,95% CI:0.56-5.22) or the rate of reoperations (OR=0.98,95% CI: 0.33-2.90) between the two groups. Sequential analysis of the trial showed that the cumulative level of patient satisfaction crossed the traditional boundary and that of trial sequential analysis, which confirmed the clinical efficacy of BT in improving patient satisfaction. However, the cumulative number of patients who resumed activity crossed the traditional boundary rather than the trial sequence monitoring boundary, suggesting that the evidence was insufficient and inconclusive.Conclusions BT can improve postoperative satisfaction levels of patients more significantly than LR,and proves to be quite safe with no high incidence of complications or reoperations. However, more high-quality randomized controlled trials need to be included for further verification.