非手术与反向肩关节置换术治疗肱骨近端3部或4部骨折：系统回顾和荟萃分析

Q2 Medicine

Journal of Clinical Orthopaedics and Trauma Pub Date : 2025-03-22 DOI:10.1016/j.jcot.2025.102982

Victor Yan Zhe Lu , Halia Shah , Zainab Alshaber , Aaron Limonard , Peter Domos

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引用次数: 0

摘要

背景：肱骨近端骨折（phf）是老年患者常见的损伤，但关于最佳治疗方案尚无共识。近年来，在老年复杂骨折患者中使用反向肩关节置换术（RSA）越来越多。本系统综述和荟萃分析将比较RSA和非手术治疗老年人3部分或4部分phf的结果。方法本研究按照PRISMA声明方案进行，在PROSPERO注册（CRD42023439647）。在四个数据库（Medline, Embase， Web of Science和Cochrane Library）中进行了检索，并纳入了使用RSA与保守管理结果的比较研究。收集人口统计数据、患者相关结果测量（PROMs）和并发症发生率。数据采用随机效应模型汇总。采用I2统计量和Cochran’s Q检验确定异质性。结果6项研究纳入439例患者(平均年龄79.0岁；12.1%为男性)。平均Charlson合并症指数（CCI）为3.74，随访26.0个月。与非手术组相比，RSA组的VAS评分更高(1.0比0.575；p = 0.047)， Constant-Murley评分(66.3比71；P = 0.114)，主动前屈(121.5°vs 100°；p = 0.023；I2 = 35%)，外旋(34.8°vs 23.1°；p = 0.020)和内旋(恒定评分5.44 vs 4.28；p = 0.169)。并发症的总体风险没有差异(8.2% vs 6.0%；rr = 1.00；p = 0.993)，但接受RSA治疗的患者需要后续翻修手术的风险更高(3.7%对2.8%；p = 0.640；i2 = 25%)。结论在短期内，与非手术治疗的患者相比，RSA治疗的老年复杂phf患者疼痛减轻，Constant-Murley评分增加，ROM增加，但需要后续手术的风险较高。然而，研究间效应大小的中等异质性和纳入研究的回顾性可能限制了本综述结论的临床应用。证据水平ii。

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Non-operative versus reverse shoulder arthroplasty for the treatment of 3- or 4-part proximal humeral fractures: A systematic review and meta-analysis

Background

Proximal humerus fractures (PHFs) are a common injury experienced by elderly patients, however there is no consensus regarding the best treatment option. Recently, the use of reverse shoulder arthroplasty (RSA) in elderly patients with complex fractures is increasing. This systematic review and meta-analysis will compare the outcomes between RSA and non-operative treatment in 3- or 4-part PHFs in the elderly.

Methods

This study was conducted according to the PRISMA statement protocol and registered in PROSPERO (CRD42023439647). Searches on four databases (Medline, Embase, Web of Science, and Cochrane Library) were performed, and comparative studies which compared the outcomes of using RSA with conservative management were included. Demographic data, patient related outcome measures (PROMs), and complications rates were collected. Data were pooled using a random-effects model. Heterogeneity was determined using the I² statistic and Cochran's Q test.

Results

Six studies involving 439 patients (mean age 79.0 years old; 12.1 % male) were analysed. The average Charlson co-morbidity index (CCI) was 3.74 and follow-up time was 26.0 months. Compared to the non-operative cohort, the RSA cohort had better VAS scores (1.0 versus 0.575; p = 0.047), Constant-Murley scores (66.3 versus 71; p = 0.114), active forward flexion (121.5° versus 100°; p = 0.023; I² = 35 %), external rotation (34.8° vs 23.1°; p = 0.020), and internal rotation (Constant score 5.44 versus 4.28; p = 0.169). There is no difference in the overall risk of complications (8.2 % versus 6.0 %; RR = 1.00; p = 0.993), but those treated by RSA have a higher risk of needing subsequent revision surgery (3.7 % versus 2.8 %; p = 0.640; I² = 25 %).

Conclusion

In the short-term, elderly patients with complex PHFs treated with RSA may have decreased pain, increased Constant-Murley scores, and increased ROM compared with patients treated non-operatively, at the expense of a higher risk of needing subsequent surgery. However, moderate between-study heterogeneity in effect sizes and the retrospective nature of included studies may limit the clinical applications of conclusions obtained in this review.

Level of evidence

III.

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来源期刊

Journal of Clinical Orthopaedics and Trauma Medicine-Orthopedics and Sports Medicine

CiteScore

4.30

自引率

0.00%

发文量

181

审稿时长

92 days

期刊介绍： Journal of Clinical Orthopaedics and Trauma (JCOT) aims to provide its readers with the latest clinical and basic research, and informed opinions that shape today''s orthopedic practice, thereby providing an opportunity to practice evidence-based medicine. With contributions from leading clinicians and researchers around the world, we aim to be the premier journal providing an international perspective advancing knowledge of the musculoskeletal system. JCOT publishes content of value to both general orthopedic practitioners and specialists on all aspects of musculoskeletal research, diagnoses, and treatment. We accept following types of articles: • Original articles focusing on current clinical issues. • Review articles with learning value for professionals as well as students. • Research articles providing the latest in basic biological or engineering research on musculoskeletal diseases. • Regular columns by experts discussing issues affecting the field of orthopedics. • "Symposia" devoted to a single topic offering the general reader an overview of a field, but providing the specialist current in-depth information. • Video of any orthopedic surgery which is innovative and adds to present concepts. • Articles emphasizing or demonstrating a new clinical sign in the art of patient examination is also considered for publication. Contributions from anywhere in the world are welcome and considered on their merits.