University of Alabama at Birmingham, Birmingham, AL 35294-3408, USA.
J Rheumatol. 2011 Apr;38(4):598-605. doi: 10.3899/jrheum.101008. Epub 2011 Jan 15.
To determine the benefits and harm of surgery for shoulder osteoarthritis (OA).
We performed a Cochrane Systematic Review of clinical trials of adults with shoulder OA, comparing surgical techniques [total shoulder arthroplasty (TSA), hemiarthroplasty, implant types, and fixation] to placebo, sham surgery, nonsurgical modalities, and no treatment. We also reviewed trials that compared various surgical techniques, reporting patient-reported outcomes (pain, function, quality of life, etc.) or revision rates. We calculated the risk ratio for categorical outcomes and mean differences for continuous outcomes with 95% CI.
There were no controlled trials of surgery versus placebo or nonsurgical interventions. Seven studies with 238 patients were included. Two studies compared TSA to hemiarthroplasty (n = 88). Significantly worse scores on the 0-100 American Shoulder and Elbow Surgeons scale (mean difference, -10.05 at 24-34 mo; 95% CI -18.97 to -1.13; p = 0.03) and a nonsignificant trend toward higher revision rate in hemiarthroplasty compared to TSA (relative risk 6.18; 95% CI 0.77 to 49.52; p = 0.09) were noted. With 1 study providing data (n = 41), no differences were noted between groups for pain scores (mean difference 7.8; 95% CI -5.33 to 20.93), quality of life on Medical Outcomes Study Short-Form 36 physical component summary (mean difference 0.80; 95% CI -6.63 to -8.23), and adverse events (relative risk 1.2; 95% CI 0.4 to 3.8).
TSA was associated with better shoulder function, with no other demonstrable clinical benefits compared to hemiarthroplasty. More studies are needed to compare clinical outcomes between them and comparing shoulder surgery to sham, placebo, and other nonsurgical treatment options.
确定肩部骨关节炎（OA）手术的益处和危害。
我们对成人肩部 OA 的临床试验进行了 Cochrane 系统评价，比较了手术技术（全肩关节置换术（TSA）、半肩关节置换术、植入物类型和固定方式）与安慰剂、假手术、非手术方式和不治疗的效果。我们还回顾了比较各种手术技术的试验，报告了患者报告的结果（疼痛、功能、生活质量等）或翻修率。我们使用 95%CI 计算了分类结果的风险比和连续结果的均数差值。
没有手术与安慰剂或非手术干预的对照试验。纳入了 7 项研究，共 238 例患者。有 2 项研究比较了 TSA 与半肩关节置换术（n = 88）。24-34 个月时美国肩肘外科医师协会 0-100 评分（平均差值，-10.05；95%CI -18.97 至 -1.13；p = 0.03）显著更差，且半肩关节置换术的翻修率有升高的趋势（相对风险 6.18；95%CI 0.77 至 49.52；p = 0.09）。有 1 项研究提供了数据（n = 41），两组之间疼痛评分（平均差值 7.8；95%CI -5.33 至 20.93）、医疗结局研究短式 36 健康调查量表躯体成分摘要评分（平均差值 0.80；95%CI -6.63 至 -8.23）和不良事件（相对风险 1.2；95%CI 0.4 至 3.8）无差异。
与半肩关节置换术相比，TSA 与更好的肩部功能相关，没有其他可证明的临床益处。需要更多的研究来比较它们之间的临床结果，并比较肩部手术与假手术、安慰剂和其他非手术治疗选择。
