Sayegh Eli T, Mascarenhas Randy, Chalmers Peter N, Cole Brian J, Romeo Anthony A, Verma Nikhil N
College of Physicians and Surgeons, Columbia University, New York, New York, U.S.A..
Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, Illinois, U.S.A.
Arthroscopy. 2015 Jun;31(6):1156-1166.e8. doi: 10.1016/j.arthro.2014.11.012. Epub 2014 Dec 25.
The aim of this study was to compare surgical treatment options for young patients with glenohumeral arthritis.
A systematic review of the English-language literature was conducted by searching PubMed, EMBASE, and Scopus with the following term: "(shoulder OR glenohumeral) AND (arthritis OR osteoarthritis) AND (young OR younger)." Studies that reported clinical or radiological outcomes of nonbiologic surgical treatment of generalized glenohumeral arthritis in patients younger than 60 years of age were included. Data were extracted to include study and patient characteristics, surgical technique, outcome scores, pain relief, satisfaction, functional improvement, return to activity, health-related quality of life, complications, need for and time to revision, range of motion, and radiological outcomes. Study quality was assessed with the Modified Coleman Methodology Score.
Thirty-two studies containing a total of 1,229 shoulders met the inclusion criteria and were included in the review. Pain scores improved significantly more after total shoulder arthroplasty (TSA) than after hemiarthroplasty (HA) (P < .001). Patient satisfaction was similar after HA and TSA. Revision surgery was equally likely after HA, TSA, and arthroscopic debridement (AD). Complications were significantly less common after AD than after HA (P = .0049) and TSA (P < .001). AD and TSA afforded better recovery of active forward flexion and external rotation than did HA. At radiological follow-up, subluxation was similarly common after HA and TSA.
According to current Level IV data, TSA provides greater improvement of pain and range of motion than does HA in the surgical treatment of young patients with glenohumeral arthritis. AD is an efficacious and particularly safe alternative in the short term for young patients with concerns about arthroplasty.
Level IV, systematic review of Level IV studies.
本研究旨在比较年轻的肩肱关节关节炎患者的手术治疗方案。
通过在PubMed、EMBASE和Scopus数据库中检索以下术语进行英文文献的系统综述：“（肩部或肩肱关节）AND（关节炎或骨关节炎）AND（年轻或更年轻）”。纳入报告60岁以下患者广泛性肩肱关节关节炎非生物手术治疗的临床或放射学结果的研究。提取的数据包括研究和患者特征、手术技术、结果评分、疼痛缓解、满意度、功能改善、恢复活动情况、健康相关生活质量、并发症、翻修的必要性和时间、活动范围以及放射学结果。采用改良科尔曼方法评分评估研究质量。
32项研究共纳入1229个肩部，符合纳入标准并纳入本综述。全肩关节置换术（TSA）后疼痛评分的改善明显大于半肩关节置换术（HA）（P < .001）。HA和TSA后的患者满意度相似。HA、TSA和关节镜清创术（AD）后翻修手术发生的可能性相同。AD后并发症的发生率明显低于HA（P = .0049）和TSA（P < .001）。与HA相比，AD和TSA能使主动前屈和外旋恢复得更好。在放射学随访中，HA和TSA后半脱位的发生率相似。
根据当前的IV级数据，在年轻的肩肱关节关节炎患者的手术治疗中，TSA比HA能更好地改善疼痛和活动范围。对于担心关节置换术的年轻患者，AD在短期内是一种有效且特别安全的选择。
IV级，IV级研究的系统综述。
