切口缝合技术的临床效果与解剖型全肩关节置换术相当，但并发症发生率较高：系统回顾和荟萃分析

IF 1.5 Q3 ORTHOPEDICS

Journal of orthopaedics Pub Date : 2025-04-14 DOI:10.1016/j.jor.2025.04.003

Omar E. S. Mostafa , Robert W. Jordan , Tanujan Thangarajah , Simon MacLean , Jarret Woodmass , Peter D'Alessandro , Shahbaz S. Malik

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引用次数: 0

摘要

目的本综述旨在探讨Ream and Run （RnR）技术是否比传统的解剖性全肩关节置换术（aTSA）治疗骨关节炎具有更好的疗效和更低的并发症。方法于2024年3月2日按照PRISMA指南，使用Medline、Embase和Cochrane进行系统检索。仅纳入了成人关节肱骨关节炎（OA）患者RnR和aTSA的比较研究。提取和分析基本人口统计学、患者报告的结果测量（PROMs）和并发症。使用纽卡斯尔-渥太华评分（NOS）工具进行质量评估，使用Cochrane RevMan Web对两项或两项以上研究报告的结果进行荟萃分析。结果8项研究共纳入1548例患者[RnR 738 vs aTSA 810]。RnR组患者的平均年龄为52.8 ~ 60.3岁，其中93.6%为男性，而aTSA组患者的平均年龄为53 ~ 67.5岁，其中56%为男性。RnR组中有5例患者为Walch C级或D级，而aTSA组为3例。两组术后SST评分差异无统计学意义[P <；0.04]、术后as评分[P = 0.57]或术后前屈程度[P <；0.41]。术后外旋度有统计学意义的改善，有利于RnR [MD -8.35, 95% CI -14.69 ~ - 2.01, P <；[0.01]但无显著临床意义。RnR组和aTSA组的总并发症发生率分别为15.4%和5.3%。RnR组最常见的并发症是慢性疼痛和僵硬（3.9%），aTSA组最常见的并发症是软组织衰竭（2.7%）。RnR组的总体复诊率为7%，aTSA组为2.7%。结论aTSA和RnR均能改善肩关节PROMS。但RnR组总体再手术率及并发症发生率较高。技术的选择应根据患者的术前基线、活动水平和期望目标进行调整。

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Ream-and-run technique offers equivalent clinical outcomes as anatomical total shoulder arthroplasty but with a high rate of complications: A systematic review and meta-analysis

Purpose

This review aims to explore if the Ream and Run (RnR) technique is associated with better outcomes and lower complications than the traditional Anatomical Total Shoulder Replacement (aTSA) for osteoarthritis.

Methods

A systematic search of the literature was conducted using Medline, Embase and Cochrane in accordance with the PRISMA guidelines on March 2, 2024. Only comparative studies of adult patients with glenohumeral osteoarthritis (OA) comparing RnR and aTSA were included. Basic demographics, patient-reported outcome measures (PROMs) and complications were extracted and analysed. Quality assessment was performed using the Newcastle-Ottawa Score (NOS) tool and meta-analysis of outcomes reported by two or more studies was performed using Cochrane RevMan Web.

Results

A total of 1548 patients were pooled from eight studies [RnR 738 vs aTSA 810]. Mean age in the RnR group ranged from 52.8 to 60.3 years with 93.6 % being male, compared with age range of 53–67.5 years in the aTSA group with 56 % being male. Five patients in the RnR group were Walch grade C or D, compared with three patients in the aTSA. No difference was observed between the two groups in post-operative SST score [P < 0.04], post-operative ASES score [P = 0.57] or degree of post-operative forward flexion [P < 0.41]. There was a statistically significant improvement in post-operative degree of external rotation, favouring RnR [MD -8.35, 95 % CI -14.69 to −2.01, P < 0.01] but without a significant clinical importance. The overall rate of complications in the RnR group was 15.4 % and 5.3 % in the aTSA group. The commonest reported complication in RnR group was chronic pain and stiffness (3.9 %) and soft tissue failure in the aTSA group (2.7 %). Overall rate of return-to-theatre was 7 % in RnR and 2.7 % in aTSA group.

Conclusion

Both aTSA and RnR offer improvement in shoulder PROMS. However, the overall re-operation rate and complications appeared high in RnR group. The choice of technique should be tailored to the patient's pre-operative baseline, activity level and desired goals.

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来源期刊

Journal of orthopaedics ORTHOPEDICS-

CiteScore

3.50

自引率

6.70%

发文量

202

审稿时长

56 days

期刊介绍： Journal of Orthopaedics aims to be a leading journal in orthopaedics and contribute towards the improvement of quality of orthopedic health care. The journal publishes original research work and review articles related to different aspects of orthopaedics including Arthroplasty, Arthroscopy, Sports Medicine, Trauma, Spine and Spinal deformities, Pediatric orthopaedics, limb reconstruction procedures, hand surgery, and orthopaedic oncology. It also publishes articles on continuing education, health-related information, case reports and letters to the editor. It is requested to note that the journal has an international readership and all submissions should be aimed at specifying something about the setting in which the work was conducted. Authors must also provide any specific reasons for the research and also provide an elaborate description of the results.