Rothman Institute, Thomas Jefferson University Hospital, 925 Chestnut Street, 5th Floor, Philadelphia, PA 19107. E-mail address:
J Bone Joint Surg Am. 2013 Sep 18;95(18):1701-8. doi: 10.2106/JBJS.L.01115.
Complex proximal humeral fractures that are not amenable to surgical fixation represent a difficult treatment problem. The purpose of this systematic review was to critically examine the outcomes of reverse shoulder arthroplasty and hemiarthroplasty (with use of a fracture-specific stem) for the treatment of proximal humeral fractures.
A systematic review of the literature was performed by means of a search of electronic databases. Two reviewers independently assessed the methodological quality and extracted relevant data from each included study. When outcomes data were similar among studies, the data were pooled by means of frequency-weighted values to generate summary outcomes.
Fourteen studies fulfilled all inclusion and exclusion criteria and were included. Patients were followed for a frequency-weighted mean of 43.5 months in the reverse arthroplasty group and 31.1 months in the hemiarthroplasty group (p = 0.228). Subjective outcomes (including the Constant score, Constant pain subscore, and American Shoulder and Elbow Surgeons [ASES] score) and range-of-motion parameters (including active forward elevation, abduction, and external rotation) were similar between the two groups. Compared with hemiarthroplasty, reverse arthroplasty was associated with 4.0 times greater odds of a postoperative complication.
The compiled data and frequency-weighted means demonstrated improvement in function, pain, and range of motion after reverse arthroplasty and hemiarthroplasty. Patients and physicians should consider projected functional outcomes, implant costs, and complication rates when selecting an appropriate arthroplasty technique for this indication.
无法进行手术固定的复杂肱骨近端骨折是一个治疗难题。本系统评价的目的是批判性地评估反式肩关节置换术和人工肱骨头置换术（使用特定于骨折的柄）治疗肱骨近端骨折的效果。
通过电子数据库检索进行了系统的文献回顾。两位评审员独立评估了每个纳入研究的方法学质量并提取了相关数据。当研究之间的结果数据相似时，通过频率加权值汇总数据以生成汇总结果。
符合所有纳入和排除标准的 14 项研究被纳入。反式关节置换组的随访频率加权平均值为 43.5 个月，半关节置换组为 31.1 个月（p=0.228）。两组的主观结果（包括 Constant 评分、Constant 疼痛评分和美国肩肘外科医生协会评分）和活动范围参数（包括主动前屈、外展和外旋）相似。与半关节置换相比，反式关节置换术后并发症的几率增加了 4.0 倍。
综合数据和频率加权平均值表明，反式关节置换术和半关节置换术后功能、疼痛和活动范围均有改善。在选择治疗该适应证的合适关节置换技术时，患者和医生应考虑预期的功能结果、植入物成本和并发症发生率。
