Marcheggiani Muccioli Giulio Maria, Huri Gazi, Grassi Alberto, Roberti di Sarsina Tommaso, Carbone Giuseppe, Guerra Enrico, McFarland Edward G, Doral Mahmut N, Marcacci Maurilio, Zaffagnini Stefano
Dipartimento Rizzoli Sicilia, Istituto Ortopedico Rizzoli, University of Bologna, via di Barbiano, 1/10 - c/o Lab Biomeccanica ed Innovazione Tecnologica, 40136, Bologna, Italy.
Department of Sports Medicine, University of Hacettepe, Ankara, Turkey.
Int Orthop. 2017 Apr;41(4):823-830. doi: 10.1007/s00264-017-3399-0. Epub 2017 Jan 26.
To investigate the best surgical management of infected shoulder arthroplasty.
A literature review from 1996 to 2016 identified 15 level IV studies that met inclusion criteria. Persistent infection (PI) was considered as treatment failure. Success was regarded as the absence of symptomatic PI without necessity for further treatment. Surgical outcomes were reported according to the mean weighted Constant and Murley score (CMS) for each treatment group.
Overall, 287 patients (146 males/141 females) were identified at a mean follow-up of 50.4 (range 32-99.6) months. The PI in the whole population was 11.5%. The pooled mean CMS, available for 218 patients, was 39 ± 13. Twenty-seven patients (9.4%) were treated with debridement (PI 29.6%, CMS 41 ± 12), 52 patients (18.1%) with resection arthroplasty (PI 11.5%, CMS 29 ± 16), 33 patients (11.5%) with permanent spacers (PI 6.1%, CMS 31 ± 14), 98 patients (34.2%) with two-stage revisions (PI 14.3%, CMS 42 ± 12) and 77 patients (26.8%) with one-stage revisions (PI 3.9%, CMS 49 ± 11). Debridement showed the highest PI rate (29.6%) and one-stage revisions reported the lowest PI rate (3.9%). Resection arthroplasty and spacers showed the poorest CMS when compared to the other procedures (p ≤ 0.0001). The debridement PI rate was significantly higher than almost any other procedure. CMS was significantly higher in patients undergoing revision compared to non-revision procedures (45 ± 12 vs. 35 ± 14) (p < 0.0001). One-stage revisions achieved significantly better results in terms of the PI rate compared to two-stage revisions (p = 0.0223), but not in terms of CMS.
Debridement showed the highest PI rate (29.6%) and should not be recommended for the management of infected shoulder arthroplasty. Revisions reported better functional outcomes compared to non-revision procedures. The presence of a significantly lower PI rate with comparablely high mean CMS values suggests that one-stage (where technically applicable) could be superior to two-stage revisions. Unfortunately, well-designed randomized controlled trials using validated patient-based outcomes are lacking in this field.
Systematic Review of level IV studies, Level IV.
探讨感染性肩关节置换术的最佳手术治疗方法。
对1996年至2016年的文献进行回顾，确定了15项符合纳入标准的IV级研究。持续性感染（PI）被视为治疗失败。成功定义为无症状性PI且无需进一步治疗。根据每个治疗组的平均加权Constant和Murley评分（CMS）报告手术结果。
总体而言，共纳入287例患者（男146例/女141例），平均随访50.4个月（范围32 - 99.6个月）。总体人群的PI发生率为11.5%。218例患者的合并平均CMS为39±13。27例患者（9.4%）接受清创术治疗（PI发生率29.6%，CMS为41±12），52例患者（18.1%）接受关节切除成形术（PI发生率11.5%，CMS为29±16），33例患者（11.5%）植入永久性间隔物（PI发生率6.1%，CMS为31±14），98例患者（34.2%）接受两期翻修术（PI发生率14.3%，CMS为42±12），7
