Brorson Stig, Rasmussen Jeppe V, Olsen Bo S, Frich Lars H, Jensen Steen L, Hróbjartsson Asbjørn
Department of Orthopaedic Surgery, Herlev University Hospital, Herlev, Denmark.
Int J Shoulder Surg. 2013 Apr;7(2):70-8. doi: 10.4103/0973-6042.114225.
The indications for surgical intervention in complex fractures of the proximal humerus are disputed. In elderly patients with poor bone stock it may be impossible to obtain satisfactory fixation of the tuberosities to a hemiarthroplasty (HA). In such cases primary insertion of a reverse shoulder arthroplasty (RSA) has been suggested. We aimed to review clinical studies reporting benefits and harms of RSA in acute fractures. A systematic review. We included 18 studies containing 430 RSA in acute fractures. We found no randomized clinical trials. Four studies compared outcome after RSA with a historical control group of HA. The median constant score was 58 (range 44-68) which is comparable to previous reviews of HA in 4-part fractures. Complications included dislocation, infection, hematoma, instability, neurological injury, reflex sympathetic dystrophy, intraoperative fractures, periprosthetic fractures, and baseplate failure. Scapular notching was reported in 11 studies with a median value of 25% (range 0-94). Heterogeneity of study designs and lack of primary data precluded statistical pooling of data. No high quality evidence was identified. Based on the available evidence the use of RSA in acute fractures is questionable. The complication rate was high and the clinical implications of long term scapular notching are worrying. Randomized studies with long term follow up using the latest techniques of tubercular reinsertion in RSA toward HA should be encouraged.
肱骨近端复杂骨折的手术干预指征存在争议。对于骨质较差的老年患者，可能无法将结节满意地固定到半关节置换术（HA）上。在这种情况下，有人建议初次植入反肩关节置换术（RSA）。我们旨在回顾报告RSA在急性骨折中利弊的临床研究。进行系统评价。我们纳入了18项研究，其中包含430例急性骨折中的RSA。我们未发现随机临床试验。四项研究将RSA后的结果与HA的历史对照组进行了比较。Constant评分中位数为58（范围44 - 68），这与先前对四部分骨折中HA的综述相当。并发症包括脱位、感染、血肿、不稳定、神经损伤、反射性交感神经营养不良、术中骨折、假体周围骨折和基板故障。11项研究报告了肩胛切迹，中位数为25%（范围0 - 94）。研究设计的异质性和缺乏原始数据妨碍了数据的统计合并。未发现高质量证据。基于现有证据，RSA在急性骨折中的应用存在疑问。并发症发生率较高，长期肩胛切迹的临床影响令人担忧。应鼓励采用RSA向HA中结节重新植入的最新技术进行长期随访的随机研究。
